Publications by authors named "Blackstone E"
Objective: Based on current practice guidelines, we hypothesized that most patients with esophageal cancer, particularly those with locally advanced cancer, would benefit from adjuvant therapy after esophagectomy esophagectomy alone. We sought to obtain a granular estimate of patient-level risk-adjusted survival for each therapeutic option by cancer histopathology and stage.
Background: Although esophagectomy alone is now an uncommon therapy for treating locally advanced esophageal cancer, the value of adjuvant therapy after esophagectomy is unknown.
Objective: To characterize the clinical courses and outcomes of patients presenting with post-myocardial infarction (MI) ventricular septal rupture (VSR) receiving temporary microaxial transvalvular left ventricular assist device (tVAD) support.
Methods: Between December 2019 and July 2023, 10 consecutive patients presented with a post-MI VSR. All 10 patients received a tVAD.
Article Synopsis
- The BeSPoKE technique is a surgical method used to enlarge the aortic outflow tract in adults with complex heart issues, specifically those facing aortic stenosis and prosthesis-patient mismatch.
- A study involving 25 adults showed significant improvement in aortic valve gradients post-surgery, with a median size increase of the prosthesis and no reports of operative mortality.
- Postoperative complications included atrial fibrillation and heart block, but overall survival at two years was high at 92%, indicating that this technique is a safe and effective option for patients with small left ventricular outflow tracts.
Inconsistencies with reported point estimates and adjusted odds ratios.
Cardiovasc Revasc Med
November 2024
Objectives: To identify possible etiology-specific differences in preoperative risk factors for major adverse events during Impella 5.5 support in patients with ischemic (ICM) and nonischemic cardiomyopathy (NICM).
Methods: From October 2019 to January 2023, 228 Impella 5.
Objectives: We assessed the effect of anomalous aortic origin of a coronary artery on the risk of early and late postoperative events after aortic or mitral valve replacement in adults.
Methods: Between 2005 and 2022, 29,579 adults underwent surgical aortic or mitral valve replacement at Cleveland Clinic. Among these, 29 had an unrepaired coronary artery rising anomalously from the aorta that was not intervened upon during valve surgery, 19 (65%) an anomalous circumflex, and 9 (31%) an anomalous right.
Article Synopsis
- This study aimed to investigate mitral calcification in patients with severe aortic stenosis and mitral regurgitation, assessing its impact on heart structure, surgical interventions, and survival rates.
- Researchers examined 158 patients who underwent various surgical procedures from 1998 to 2010, using CT scans to measure mitral calcium and employing random forest methodology to analyze its relationship with heart function.
- Findings revealed that larger mitral calcium volumes indicated more severe heart disease and required more complex surgical procedures, but contrary to expectations, it did not correlate with long-term survival outcomes.
Article Synopsis
- The study aimed to assess if using multiple arterial grafts in redo coronary artery bypass grafting (CABG) offers any advantages over using a single arterial graft.
- Over a 40-year period, researchers examined data from 6,559 patients who underwent isolated redo CABG, matching those who received multiarterial grafts with those who received single arterial grafts to evaluate in-hospital complications and long-term survival.
- Results indicated that multiarterial grafting was linked to lower in-hospital mortality and better long-term survival rates, especially in males with two internal thoracic artery grafts.
Background: Impella 5.5 is a temporary left ventricular assist device utilized to support patients with cardiogenic shock and those undergoing high-risk cardiac interventions.
Methods: From October 2019 to January 2023, 226 patients received Impella 5.
Article Synopsis
- The study introduces the esophageal length-to-height ratio (LHR) to measure the tortuosity of the esophagus in patients with achalasia, aiming to relate it to preoperative characteristics and post-surgery outcomes.
- Over 400 adult patients underwent myotomy, and the LHR was calculated pre- and postoperatively, revealing that higher LHR was associated with poorer outcomes in symptom relief and esophageal emptying.
- The findings indicate that LHR is a strong predictor of postoperative success, while the manometric subtype had a lesser impact on patient outcomes, showcasing a need for more tailored assessments in achalasia treatment.
Objective: To determine the durability of mitral valve repair (MVr) with complete ring or flexible band annuloplasty in patients with atrial functional mitral regurgitation (AFMR) due to atrial fibrillation (AF) and identify risk factors associated with postoperative recurrence of mitral regurgitation.
Methods: Between January 1, 2000, and January 1, 2023, 194 adults with a history of AF underwent MVr with annuloplasty alone for moderate/severe AFMR. Exclusion criteria were prior cardiac surgery, additional repair techniques, ejection fraction <45%, ischemic heart disease, aortic valve disease, mitral annular calcification, and concomitant procedures other than surgical ablation or tricuspid repair/replacement.
Objective: Valve-sparing aortic root replacement for proximal aortic dilation with aortic regurgitation is associated with excellent outcomes. Modified aortic reimplantation entails reducing the anulus size to the expected size for sex and body surface area and creating neosinuses to preserve the aortic valve. We present our mid- and late-term outcomes with the modified technique, including a single-surgeon's experience over the past 2 decades.
View Article and Find Full Text PDFObjective: To demonstrate the application of American Association for Thoracic Surgery Quality Gateway (AQG) outcomes models to a Surgeon Case Study of quality assurance in adult cardiac surgery.
Methods: The case study includes 6989 cardiac and thoracic aorta operations performed in adults at Cleveland Clinic by a single surgeon between 2001 and 2023. AQG models were used to predict expected probabilities for operative mortality and major morbidity and to compare hospital outcomes, surgery type, risk profile, and individual risk factor levels using virtual (digital) twin causal inference.
Objective: The study objective was to develop comprehensive quality assurance models for procedural outcomes after adult cardiac surgery.
Methods: Based on 52,792 cardiac operations in adults performed in 19 hospitals of 3 high-performing hospital systems, models were developed for operative mortality (n = 1271), stroke (n = 895), deep sternal wound infection (n = 122), prolonged intubation (6182), renal failure (1265), prolonged postoperative stay (n = 5418), and reoperations (n = 1693). Random forest quantile classification, a method tailored for challenges of rare events, and model-free variable priority screening were used to identify predictors of events.
Article Synopsis
- - Surgical registries are important for improving healthcare quality, but they require a lot of resources to manage due to the complexity of medical data, making automation with natural language processing (NLP) appealing yet challenging due to dynamic data requirements.
- - The study evaluates a new model called Cardiovascular Surgery Bidirectional Encoder Representations from Transformers (CS-BERT) designed to automate the data entry for the Society of Thoracic Surgeons’ adult cardiac surgery registry, demonstrating its effectiveness across various sites and registry versions.
- - CS-BERT achieved a high performance score for common surgeries, suggesting it could reduce the need for costly manual data entry, though further research is required for capturing less common procedures due to limited data availability.
Objective: In order to predict at hospital admission the prognosis of patients with serious and life-threatening COVID-19 pneumonia, we sought to understand the clinical characteristics of hospitalised patients at admission as the SARS-CoV-2 pandemic progressed, document their changing response to the virus and its variants over time, and identify factors most importantly associated with mortality after hospital admission.
Design: Observational study using a prospective hospital systemwide COVID-19 database.
Setting: 15-hospital US health system.
Objective: To maximize successful repair of bicuspid aortic valves by adding figure-of-8 hitch-up stitches at commissures.
Methods: From 2000 to 2022, bicuspid aortic valve repair was performed on 1112 patients at Cleveland Clinic, with 367 patients receiving figure-of-8 hitch-up stitches along with classical techniques, including Cabrol suture, cusp plication, raphe resection, and valve-sparing root replacement. Operative outcomes, repair durability, and survival were assessed in the figure-of-8 hitch-up stitches cohort, and outcomes were compared among 195 balancing-score-matched patient pairs who underwent bicuspid aortic valve repair with and without figure-of-8 hitch-up stitches.
Efficacy and safety of a transaortic approach to midventricular and apical septal myectomy.
J Thorac Cardiovasc Surg
December 2024
Objective: The study objective was to evaluate the safety and efficacy of a transaortic approach to midventricular and apical septal myectomy in patients with hypertrophic cardiomyopathy with left ventricular outflow tract or midventricular obstruction.
Methods: From January 2018 to August 2023, 940 patients underwent transaortic septal myectomy at the Cleveland Clinic, of whom 682 (73%) had midventricular or apical resection. Patients who underwent isolated basal myectomies were excluded.
Objective: Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements.
View Article and Find Full Text PDFObjectives: To identify preoperative predictors of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy and evaluate trajectory of postoperative ventricular function.
Methods: From January 2017 to January 2020, 238 patients with ejection fraction <30% (206/238) or 30% to 34% with at least moderately severe mitral regurgitation (32/238) underwent conventional cardiac surgery at Cleveland Clinic, 125 with ischemic and 113 with nonischemic cardiomyopathy. Preoperative ejection fraction was 25 ± 4.
Infective Endocarditis in Patients Addicted to Injected Opioid Drugs.
J Am Coll Cardiol
February 2024
Article Synopsis
- Persons who inject drugs and undergo surgery for infective endocarditis face serious challenges, including high rates of loss to follow-up, relapse, and mortality despite low in-hospital death rates.
- The study analyzed 227 patients from 2010 to 2020, revealing that heroin was the most commonly injected drug and highlighting significant psychosocial issues such as homelessness and mental health disorders.
- Findings indicated a need for improved postoperative addiction management strategies, as a significant portion of patients experienced relapse and loss to follow-up, demonstrating the urgent requirement for effective interventions.
Article Synopsis
- Vitamin K antagonists like warfarin are currently the approved oral anticoagulants for preventing complications in patients with mechanical heart valves, but the efficacy of apixaban in this context was unknown.
- In a trial comparing apixaban to warfarin for patients with On-X mechanical aortic valves, there were significantly more thromboembolic events in the apixaban group, leading to the study being halted after enrolling 863 participants.
- The results showed that apixaban was less effective than warfarin, failing to meet the criteria for noninferiority in preventing valve thrombosis, and had comparable but slightly lower major bleeding rates.