Publications by authors named "Gerald Sardella"
Background: The Northern New England Cardiovascular Disease Study Group (NNECDSG) was founded in 1987 as a regional consortium to improve cardiovascular quality in Maine, New Hampshire, and Vermont. We sought to assess the longitudinal impact of the NNECDSG on quality and cost of coronary artery bypass grafting (CABG) during the past 30 years.
Methods: Patients undergoing isolated CABG at 5 medical centers from 1987-2017 were retrospectively reviewed (n = 67,942).
Objective: 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.
Background: 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 PDFComparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention in a real-world Surgical Treatment for Ischemic Heart Failure trial population.
J Thorac Cardiovasc Surg
October 2018
Objective: 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: 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.
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.
Background: Whether delaying coronary artery bypass grafting (CABG) after myocardial infarction (MI) is associated with better outcomes or is an unnecessary use of health care resources is unclear. This study investigated the relationship between MI-to-CABG timing on in-hospital death.
Methods: From the Northern New England Cardiovascular Disease Study Group (NNE) Cardiac Surgery Registry we identified 3,060 isolated CABG patients with prior MI from 2008 to 2014.
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
- 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: We examined a recent regional experience to determine the effect of a prior cardiac operation on short-term and midterm outcomes after coronary artery bypass grafting (CABG).
Methods: We identified 20,703 patients who underwent nonemergent CABG at 8 centers in northern New England from 2000 to 2008, of whom 818 (3.8%) had undergone prior cardiac operations.
Article Synopsis
- Current mortality risk prediction models for CABG surgery primarily rely on patient and disease characteristics, and there is potential to enhance them by incorporating biomarkers related to myocardial damage, inflammation, and metabolic dysfunction.
- A study followed 1,731 CABG patients to investigate how these preoperative biomarkers could affect mortality risk prediction, analyzing blood samples for various markers.
- The findings showed only a slight improvement in the model's predictive ability when including biomarkers, suggesting that adding these measures may not provide significant benefits and could be an inefficient use of healthcare resources.
Background: Use of endoscopic saphenous vein harvesting has developed into a routine surgical approach at many cardiothoracic surgical centers. The association between this technique and long-term morbidity and mortality has recently been called into question. The present report describes the use of open versus endoscopic vein harvesting and risk of mortality and repeat revascularization in northern New England during a time period (2001 to 2004) in which both techniques were being performed.
View Article and Find Full Text PDFBackground: Cardiac surgery-related acute kidney injury has short- and long-term impact on patients' risk for further morbidity and mortality. Consensus statements have yielded criteria--such as the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) criteria, and the Acute Kidney Injury Network (AKIN) criteria--to define the type and consequence of acute kidney injury. We sought to estimate the ability of both the RIFLE and and AKIN criteria to predict the risk of in-hospital mortality in the setting of cardiac surgery.
View Article and Find Full Text PDFBackground: 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.