Publications by authors named "Derek Serna-Gallegos"
Objectives: We sought to assess the effect of postoperative renal failure (RF) on outcomes and identify predictors of chronic kidney disease (CKD) post-ATAAD.
Methods: This retrospective single-center analysis included all adults with ATAAD from 2011-2023. Patients were stratified into renal failure (RF) and no RF groups.
Article Synopsis
- The study investigates spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR), focusing on whether extended aortic coverage increases the risk of SCI, which affects about 10% of patients.
- A review of 277 patients revealed that those with ≥205 mm of aorta coverage had specific risk factors like smoking and previous strokes, but there was no significant increase in SCI rates (4.7% vs. 4.2%) compared to standard coverage.
- The findings suggest that the lack of increased SCI risk with extended coverage may be due to a higher use of preventive lumbar drainage in that patient group, even though they experienced more type II endoleaks.
Article Synopsis
- The study aimed to evaluate the impact of hospital teaching status on outcomes for patients with type B aortic dissection (TBAD) using data from the National Readmissions Database over four years.
- A total of 44,981 TBAD patients were analyzed, revealing no significant differences in in-hospital mortality or 30-day readmission rates between those treated at teaching hospitals versus non-teaching hospitals.
- At teaching hospitals, the use of thoracic endovascular aortic repair (TEVAR) showed higher risks of in-hospital mortality, while higher hospital patient volumes were linked to increased chances of 30-day readmissions.
Article Synopsis
- The study aimed to assess how intraoperative neuromonitoring (IONM) affects the risk of stroke and mortality during coronary and valvular heart operations over a period of 11 years.
- Out of 19,299 patients, 589 (3.1%) received IONM, and those patients had higher pre-existing cerebrovascular diseases, resulting in increased rates of operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%).
- However, after adjusting for patient characteristics, there was no significant difference in stroke or mortality rates between IONM users and non-users, suggesting that IONM may indicate risks rather than directly influence outcomes.
Article Synopsis
- The study aimed to determine if using epiaortic ultrasound to assess aortic calcification would lower the rate of postoperative strokes in patients undergoing coronary artery bypass grafting (CABG).
- A total of 10,049 patients were analyzed, with 1,572 receiving epiaortic ultrasound. The results showed no significant difference in stroke rates between the groups, with 0.8% in the ultrasound group and 1.4% in the non-ultrasound group.
- Overall, the study concluded that epiaortic ultrasound did not significantly reduce the odds of postoperative stroke or hazards of mortality in CABG patients.
Article Synopsis
- This study evaluated how mitral regurgitation (MR) affects patient outcomes after undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS), finding significant survival differences based on MR severity.
- Out of 2250 TAVI patients, those with moderate or greater MR had lower survival rates and a higher chance of heart failure readmissions compared to those with less severe MR.
- The findings suggest the importance of monitoring MR progression after TAVI, as various clinical factors, but not procedural aspects, were linked to the persistence of significant MR, indicating a need for more research on managing combined AS and MR.
Article Synopsis
- Self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THVs) are being studied for their performance in valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), with a focus on clinical outcomes from 315 patients over a decade.
- Results showed that patients with SE THVs experienced lower aortic valve gradients both at 30 days and 1 year post-procedure compared to those with BE THVs, indicating better valve performance.
- Both types of valves showed similar survival rates and mortality, but BE THVs had a higher incidence of severe prosthesis-patient mismatch, suggesting potential differences in long-term outcomes that need further research.
Article Synopsis
- Both Total Arch Replacement (TAR) and debranching plus Thoracic Endovascular Aortic Repair (TEVAR) are effective treatments for aortic arch pathologies, but it is still uncertain which is the better option.
- A meta-analysis of 11 studies involving 1142 patients revealed no significant difference in overall survival between the two treatments, though TAR showed a significantly lower risk of needing later aortic surgeries.
- Older patients may find debranching plus TEVAR more beneficial, while those with type A aortic dissections might have better outcomes with TAR.
Patients with small aortic annuli (SAAs) are predominantly women. We sought to compare gender-based and propensity-matched outcomes of index transcatheter aortic valve replacement (TAVR) in patients with SAAs. In this retrospective institutional analysis (2012 to 2023), primary stratification was by gender.
View Article and Find Full Text PDFBackground: The relationship between the number and type of postoperative complications and mortality in the setting for surgery for acute type A aortic dissection (ATAAD) remains underexplored despite its critical role in the failure-to-rescue (FTR) metric.
Methods: This retrospective study used data from the Society of Thoracic Surgeons Adult Cardiac Surgical Database on ATAAD surgeries performed between January 2018 and December 2022. Patients were categorized based on their number of major complications.
To compare the long-term outcomes of mechanical versus bioprosthetic aortic valve replacement (AVR) in patients aged <50 years, we performed a study-level meta-analysis with reconstructed time-to-event data including studies published by December of 2023. The primary outcome was overall survival. Secondary outcomes included reoperation, major bleeding, and stroke.
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- The study compares outcomes of bioprosthetic versus mechanical valves in older patients who had surgical aortic valve replacement (SAVR), using data from 1,847 patients over a follow-up period of 6.2 years.
- It found no significant differences in early survival between valve types across age groups, but younger patients (<65 years) with bioprosthetic valves faced higher reintervention rates compared to those with mechanical valves.
- The study indicates that bioprosthetic valves are associated with a significantly higher risk of needing repeat aortic valve surgery in younger patients, highlighting the need for better validation of valve type recommendations for different age groups.
Self-expanding valves (SEV) and balloon-expandable valves (BEV) for transcatheter aortic valve implantation (TAVI) have their own features. There is a growing interest in long-term outcomes with the adoption of lifetime management in younger patients. To evaluate late outcomes in TAVI with SEV versus BEV, we performed a study-level meta-analysis of reconstructed time-to-event data published by May 31, 2023.
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- Tricuspid valve replacement (TVR) using mechanical valves shows better long-term survival rates and lower reoperation risks compared to tissue valves, based on a review of 21 studies involving 7,166 patients.
- Patients with mechanical valves had a lower risk of death (HR 0.77) and gained an average of 2.2 more years of life (12.4 vs 10.2 years).
- While there was no significant difference in reoperation risk within the first 7 years, mechanical valves showed a substantially lower reoperation risk after 7 years (HR 0.24).
Article Synopsis
- The study aimed to evaluate the outcomes of total arch replacement (TAR) using hypothermic circulatory arrest and bilateral antegrade cerebral perfusion (bACP) for patients with acute Type A aortic dissection (ATAAD) employing an "arch first" approach.
- Researchers conducted an observational study over 11 years, analyzing data from 215 patients undergoing TAR with bACP, focusing on short-term and long-term postoperative results.
- Findings showed a 16.3% operative mortality rate, a 1-year survival rate of 77.1%, and a 5-year survival rate of 67.1%, indicating that the "arch first" approach provides acceptable short-term outcomes and reasonable long-term durability for ATA
Article Synopsis
- The study investigates the effectiveness of aortic versus non-aortic cannulation strategies in patients undergoing surgery for acute type A aortic dissections (ATAAD).
- A systematic review of 23 studies revealed that both cannulation methods had comparable ten-year overall survival rates (61.1% for aortic and 58.4% for non-aortic).
- No significant differences were found in key outcomes such as operative mortality, stroke, renal failure, or need for renal replacement therapy between the two methods, suggesting similar surgical outcomes.
Objectives: With the expanding integration of artificial intelligence (AI) and machine learning (ML) into the structural heart domain, numerous ML models have emerged for the prediction of adverse outcomes after transcatheter aortic valve implantation (TAVI). We aim to identify, describe, and critically appraise ML prediction models for adverse outcomes after TAVI. Key objectives consisted in summarizing model performance, evaluating adherence to reporting guidelines, and transparency.
View Article and Find Full Text PDFIntroduction: Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings.
Evidence Acquisition: A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes.
Acute aortic dissection (AAD) is a rare and potentially fatal complication associated with transcatheter aortic valve replacement (TAVR). Owing to the paucity of existing institutional data, we sought to assess the incidence of postimplant AAD in patients who underwent TAVR at a single institution. All patients who underwent TAVR from 2013 to 2022 were retrospectively reviewed to identify those who possessed clinical or radiologic evidence of AAD after TAVR.
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- Aortic arch surgeries with hypothermic circulatory arrest (HCA) are riskier than standard cardiac surgeries, prompting a need to validate the ARCH score for mortality risk.
- The study analyzed 760 patients from 2014 to 2023, finding that while in-hospital mortality was 8.4%, the ARCH score had low effectiveness in predicting this outcome (C-statistic of 0.62).
- Despite its low predictive ability, the ARCH score demonstrated excellent calibration, indicating it can effectively estimate mortality risk when applied properly.
Article Synopsis
- The study investigated the outcomes of extracorporeal life support (ECLS) in patients who underwent surgery for acute type A aortic dissection (ATAAD), finding limited documentation on its effectiveness.
- The systematic review included 12 observational studies with 280 patients, revealing high complication rates: in-hospital mortality was 62.8%, and many suffered from neurological issues, bleeding, and renal failure.
- The research concluded that while ECLS is linked to significant risks, it can still provide a chance for survival in critical cases, suggesting that it should not be avoided by surgeons post-surgery for ATAAD.
Background: The mortality risk attributable to moderate aortic stenosis (AS) remains incompletely characterized and has historically been underestimated. We aim to evaluate the association between moderate AS and all-cause death, comparing it with no/mild AS (in a general referral population and in patients with heart failure with reduced ejection fraction).
Methods And Results: A systematic review and pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data of studies published by June 2023 was conducted to evaluate survival outcomes among patients with moderate AS in comparison with individuals with no/mild AS.
Objectives: Randomized controlled trials comparing transcatheter aortic valve implantation with surgical aortic valve replacement demonstrate conflicting evidence, particularly in low-risk patients. We aim to reevaluate the evidence using trial sequential analysis, balancing type I and II errors, and compare with conventional meta-analysis.
Methods: Databases were searched for randomized controlled trials, which were divided into higher-risk and lower-risk randomized controlled trials according to a pragmatic risk classification.
Objective: This study evaluates the impact of donor age on outcomes following donation after circulatory death heart transplantation.
Methods: The United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated donation after circulatory heart transplantation from January 1, 2019, to September 30, 2023. The cohort was stratified into 2 groups according to donor age, where advanced donor age was defined as 40 years or more.