Publications by authors named "Anthony W Discipio"
Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) offers an alternative to reoperative surgical aortic valve replacement. The short- and intermediate-term outcomes after ViV TAVR in the real world are not entirely clear.
Patients And Methods: A multicenter, retrospective analysis of a consecutive series of 121 ViV TAVR patients and 2200 patients undergoing primary native valve TAVR from 2012 to 2017 at six medical centers.
Objectives: The goal of this analysis was to examine the comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention among patients aged less than 60 years.
Methods: We performed a multicenter, retrospective analysis of all cardiac revascularization procedures from 2005 to 2015 among 7 medical centers. Inclusion criteria were age less than 60 years and 70% stenosis or greater in 1 or more major coronary artery distribution.
Cardiac surgery results in a multifactorial systemic inflammatory response with inflammatory cytokines, such as interleukin-10 and 6 (IL-10 and IL-6), shown to have potential in the prediction of adverse outcomes including readmission or mortality. This study sought to measure the association between IL-6 and IL-10 levels and 1-year hospital readmission or mortality following cardiac surgery. Plasma biomarkers IL-6 and IL-10 were measured in 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from eight medical centers participating in the Northern New England Cardiovascular Disease Study Group between 2004 and 2007.
View Article and Find Full Text PDFBackground: Galectin-3 (Gal-3) is a well-established biomarker of adverse clinical outcomes, but its prognostic value for long-term survival after cardiac surgery is not well understood. Elevated levels of Gal-3 have been found to be remarkably associated with higher risk of death in both acute decompensated and chronic heart failure populations. Its prognostic value for long-term survival after cardiac surgery is not known.
View Article and Find Full Text PDFObjective: The goal of this study was to examine the long-term survival of patients between the ages of 50 and 65 years who underwent tissue versus mechanical aortic valve replacement (AVR) in a multicenter cohort.
Methods: A multicenter, retrospective analysis of all AVR patients (n = 9388) from 1991 to 2015 among 7 medical centers reporting to a prospectively maintained clinical registry was conducted. Inclusion criteria were: patients aged 50 to 65 years who underwent isolated AVR.
: Soluble suppression of tumorigenicity 2 (sST2) biomarker is an emerging predictor of adverse clinical outcomes, but its prognostic value for in-hospital mortality after coronary artery bypass grafting (CABG) is not well understood. This study measured the association between operative sST2 levels and in-hospital mortality after CABG. : A prospective cohort of 1560 CABG patients were analyzed from the Northern New England Cardiovascular Disease Study Group Biomarker Study.
View Article and Find Full Text PDFBackground: The Society of Thoracic Surgeons guidelines recommend surgical ablation (SA) at the time of concomitant mitral operations, aortic valve replacement, coronary artery bypass grafting (CABG), and aortic valve replacement plus CABG for patients in atrial fibrillation (AF). The goal of this analysis was to assess the influence of SA on long-term survival.
Methods: A retrospective analysis of 20,407 consecutive CABG or valve procedures from 2008 to 2015 among seven centers reporting to a prospectively maintained clinical registry was conducted.
Background: A patient's hemoglobin (Hb) A level, regardless of diabetic status, is a measure of glycemic control. Studies have found it is an independent predictor of short-term death in patients undergoing coronary artery bypass grafting (CABG). In this study, we used preoperative HbA to assess whether levels are associated with short-term and long-term survival after CABG.
View Article and Find Full Text PDFBackground: Current preoperative models use clinical risk factors alone in estimating risk of in-hospital mortality following cardiac surgery. However, novel biomarkers now exist to potentially improve preoperative prediction models. An assessment of Galectin-3, N-terminal pro b-type natriuretic peptide (NT-ProBNP), and soluble ST2 to improve the predictive ability of an existing prediction model of in-hospital mortality may improve our capacity to risk-stratify patients before surgery.
View Article and Find Full Text PDFObjective: There are no prospective randomized trial data to guide decisions on optimal revascularization strategies for patients with multivessel coronary artery disease and reduced ejection fraction. In this analysis, we describe the comparative effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this patient population.
Methods: A multicenter, retrospective analysis of all CABG (n = 18,292) and PCIs (n = 55,438) performed from 2004 to 2014 among 7 medical centers reporting to the Northern New England Cardiovascular Disease Study Group.
Background: The goal of this study was to determine the relationship of prosthesis-patient mismatch (PPM) with long-term survival and to assess whether growing concern about PPM has resulted in a decreased incidence over time.
Methods: Using The Society of Thoracic Surgeons Adult Cardiac Surgery Database, we identified 59,779 patients ≥65 years old who underwent isolated surgical aortic valve replacement (AVR) between 2004 and 2014. The degree of PPM was calculated using literature-derived effective orifice areas for commonly used valves.
Background: Arterial conduits are preferred to venous conduits for coronary artery bypass grafting because of longer patency. A single internal mammary artery (SIMA) is used routinely. Bilateral internal mammary arteries (BIMA) are used less frequently.
View Article and Find Full Text PDFBackground: This study evaluates the influence of bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) grafting on postoperative morbidity and long-term survival among diabetic patients undergoing coronary artery bypass grafting (CABG).
Methods: A multicenter, retrospective analysis of 47,984 consecutive CABGs performed from 1992 to 2014 at 7 medical centers was conducted. Among the study population, 1,482 CABGs with BIMA were identified, and 1,297 BIMA patients were propensity-matched to 1,297 SIMA patients.
Article Synopsis
- The study aimed to analyze the adoption rate and regional differences in the use of bilateral internal mammary artery (BIMA) during coronary artery bypass grafting (CABG) among Medicare beneficiaries in the U.S. from 2009 to 2014.
- BIMA use declined nationally from 0.21 to 0.13 claims per 1,000 beneficiaries, with significant regional variation, while single internal mammary artery (SIMA) use remained stable overall.
- The research found a strong correlation between the volume of SIMA and BIMA usage regionally, suggesting that areas with higher SIMA rates also had higher chances of BIMA use, indicating a potential for increased BIMA adoption.
Background: Although previous studies have demonstrated that patients receiving bilateral internal mammary artery (BIMA) conduits during coronary artery bypass grafting have better long-term survival than those receiving a single internal mammary artery (SIMA), data on risk of repeat revascularization are more limited. In this analysis, we compare the timing, frequency, and type of repeat coronary revascularization among patients receiving BIMA and SIMA.
Methods: We conducted a multicenter, retrospective analysis of 47 984 consecutive coronary artery bypass grafting surgeries performed from 1992 to 2014 among 7 medical centers reporting to a prospectively maintained clinical registry.
Objective: Postoperative myocardial infarction remains a serious complication in cardiac surgery. The incidence and impact of this condition in acute type A aortic dissection are poorly understood.
Methods: A total of 1445 patients with acute type A aortic dissection who underwent surgery were enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2013.
Background: Of patients undergoing cardiac surgery in the United States, 15% to 20% are re-hospitalized within 30 days. Current models to predict readmission have not evaluated the association between severity of postoperative acute kidney injury (AKI) and 30-day readmissions.
Methods: We collected data from 2,209 consecutive patients who underwent either coronary artery bypass or valve surgery at 7 member hospitals of the Northern New England Cardiovascular Disease Study Group Cardiac Surgery Registry between July 2008 and December 2010.
Article Synopsis
- * A study analyzed data from 1,116 patients who underwent AVR and found that 48% had PH, which worsened the risk of complications like acute kidney injury and in-hospital mortality.
- * The research concluded that severe PH is linked to higher rates of adverse events during hospitalization and significantly reduces 5-year survival rates after AVR, highlighting the need for careful evaluation before surgery.
Article Synopsis
- About 20% of patients who have cardiac surgery end up being readmitted within 30 days, primarily due to infections and chronic diseases like diabetes and COPD.
- In a study involving 2,176 patients, those with higher pre-surgery white blood cell (WBC) counts were found to have a greater likelihood of being readmitted within 30 days.
- These findings suggest that monitoring baseline WBC counts could help healthcare teams identify patients at higher risk for readmission, improving post-surgery care.
Article Synopsis
- Patients undergoing aortic valve replacement (AVR) for severe aortic stenosis were analyzed to understand survival rates based on preoperative ejection fractions (EFs) and accompanying procedures like coronary artery bypass grafting.
- Out of 5,277 patients studied from 1992 to 2008, 14% had EFs below 40%, but preoperative EF had little impact on short-term morbidity or 30-day mortality, especially for those with isolated AVR.
- Results highlighted that patients with preserved EFs before surgery had better long-term survival, indicating that AVR should ideally be performed before any significant decline in myocardial function occurs.
Article Synopsis
- The study investigated the impact of red blood cell (RBC) transfusions on survival rates in patients undergoing cardiac surgery, focusing on those aged 80 and older.
- It found that while younger patients (under 80) had a higher risk of early death after receiving RBCs, octogenarians did not exhibit the same increased risk.
- Overall, octogenarians received RBCs more frequently than younger patients, but the transfusion did not significantly affect late death rates in either age group.
Background: Postoperative low-output failure (LOF) is an important contributor to morbidity and mortality after coronary artery bypass grafting surgery. We sought to understand which pre- and intra-operative factors contribute to postoperative LOF and to what degree the surgeon may influence rates of LOF.
Methods And Results: We identified 11 838 patients undergoing nonemergent, isolated coronary artery bypass grafting surgery using cardiopulmonary bypass by 32 surgeons at 8 centers in northern New England from 2001 to 2009.
Background And Aim Of The Study: The role of atherosclerosis and atherosclerotic risk factors in predicting progressive aortic dilatation in patients with bicuspid aortic valve (BAV) is not well defined. The study aim was to assess the role of these risk factors in progressive aortic dilatation in patients with this condition.
Methods: Adult patients were identified with BAV who displayed rapid aortic dilatation, and the association of the condition with hemodynamic and atherosclerotic risk factors was assessed.
Background: Concomitant aortic (AV) and mitral (MV) valve surgery accounts for 4% of all valve procedures in northern New England. We examined in-hospital and long-term mortality.
Methods And Results: This is a report of a prospective study of 1057 patients undergoing concomitant AV and MV surgery from 1989 to 2007.
Background: Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short- and long-term survivorship for this cohort.
Methods And Results: We conducted a cohort study of 7584 consecutive patients undergoing open aortic valve surgery without (51.