Publications by authors named "Harloff M"
Volume-outcome relations exist for transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (TEER), but how the volume of one impacts the outcomes of the other has not been studied. We, therefore, examined the association between TAVR volume and TEER outcomes using patients who underwent TEER in the Nationwide Readmissions Database from 2016 to 2018. For each year, hospitals were categorized into quartiles (first = lowest volume, fourth = highest volume) by TAVR volume.
View Article and Find Full Text PDF(1) Background: This study examines frailty's impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016-2017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator.
View Article and Find Full Text PDFObjective: With expanding eligibility criteria, transcatheter aortic valve replacement is being performed on patients with longer life expectancy, and subsequent procedures after index transcatheter aortic valve replacement are inevitable. This study examines the incidence and outcomes of patients undergoing subsequent procedural readmissions after transcatheter aortic valve replacement.
Methods: All patients who underwent index transcatheter aortic valve replacement and were discharged alive from January 2012 to December 2019 at a single institution were evaluated.
Objectives: Regional anesthetic techniques, traditionally underutilized in cardiac surgery, may play a role in multimodal analgesia, effectively improving pain control and reducing opioid consumption. We investigated the efficacy of continuous bilateral ultrasound-guided parasternal subpectoral plane blocks following sternotomy.
Methods: We reviewed all opioid-naïve patients who underwent cardiac surgery via median sternotomy under our enhanced recovery after surgery protocol between May 2018 and March 2020.
Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI.
Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV).
Methods: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers.
Article Synopsis
- - The study examines the effects of race and socioeconomic status on in-hospital outcomes for patients undergoing proximal aortic surgery, revealing significant disparities, particularly for non-White patients who often face lower income and more urgent medical situations
- - Data from nearly 33,000 patients showed no significant differences in in-hospital mortality based on race, but non-White patients had a much higher incidence of complications, indicating greater morbidity risks
- - Researchers suggest that improving access to care and focusing on nonfatal outcomes could help address the disparities observed among different racial and socioeconomic groups in cardiac surgery outcomes
The Effect of Psychosocial Risk Factors on Outcomes After Aortic Valve Replacement.
JACC Cardiovasc Interv
November 2022
Article Synopsis
- Psychosocial risk factors (PSRFs) like substance use, limited cognitive understanding, and low socioeconomic status are linked to poorer surgical outcomes after heart valve replacements, specifically in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).
- A study involving over 160,000 patients showed that those with PSRFs had higher 30-day mortality and readmission rates after SAVR, whereas for TAVR, readmissions increased but mortality rates remained unchanged.
- The findings emphasize the need to identify patients with PSRFs before surgery, as this could help healthcare providers choose the most appropriate treatment options, such as TAVR for those with less social support.
Observed versus expected morbidity and mortality in patients undergoing mitral valve repair.
Interact Cardiovasc Thorac Surg
October 2022
Objectives: Mitral valve repair (MVP) is the gold standard treatment for degenerative mitral regurgitation. With the expansion of transcatheter technologies, this study compares the outcome of MVP in low-risk and non-low-risk patients to serve as a benchmark.
Methods: This retrospective, single-institution study examined all patients who underwent MVP for primary mitral regurgitation from 2005 to 2018.
Article Synopsis
- The study examines the outcomes of a specific technique called transatrial valve-in-mitral annular calcification (ViMAC) as an alternative to traditional mitral valve surgery, focusing on a large patient registry from multiple centers.
- A total of 126 patients were analyzed, revealing that the majority had successful procedures, although some experienced post-procedure complications and one-year mortality rates were observed.
- The findings suggest that while transatrial ViMAC is generally safe, patients with moderate or severe mitral regurgitation may have a higher risk of complications and may not benefit as much from this procedure.
Objective: Acute type A aortic dissection (ATAAD) is a life-threatening condition and surgical repair often includes aortic valve replacement (AVR). Aortic valve repair (AVr) is increasingly being reported with favorable outcomes from single-center experiences. This study examined national trends and outcomes of AVr in patients with ATAAD.
View Article and Find Full Text PDFBackground: Volume-outcome relationships have been described for mitral valve repair at the institution and surgeon level. We aimed to assess whether this relationship is mitigated at high-volume (HV) mitral repair centers between HV and low-volume (LV) surgeons.
Methods: All mitral repair cases at an HV mitral center (mean, 192 annual repairs) from 1992 to 2018 were considered.
Article Synopsis
- Transcatheter aortic valve implantation (TAVI) using a percutaneous axillary approach is being evaluated for its safety and effectiveness compared to traditional surgical access.
- An international study analyzed data from 432 patients, revealing that while the percutaneous approach had a higher rate of primary hemostasis failure, it led to shorter hospital stays and lower risks of major complications.
- The findings suggest that percutaneous axillary access is as effective or potentially superior to surgical access for TAVI, especially for patients who cannot use the femoral approach.
Previous studies reported that new-onset persistent left bundle branch block (NOP-LBBB) was related to worse outcomes after transcatheter aortic valve implantation (TAVI). However, these results can be confounded by the presence of permanent pacemaker (PPM) implantation before and after TAVI. Long-term outcomes and the risk stratification of NOP-LBBB not having PPM implantation before and after TAVI have not been fully investigated.
View Article and Find Full Text PDFObjective: Female sex and lower income residence location are associated with worse health care outcomes. In this study we analyzed the national, contemporary status of socioeconomic disparities in cardiac surgery.
Methods: Adult patients within the Nationwide Readmissions Database who underwent coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), mitral valve (MV) replacement, MV repair, or ascending aorta surgery from 2016 to 2018 were included.
Studies have shown improved outcomes among married patients who underwent cardiovascular surgery; however, this has not been well studied in transcatheter aortic valve implantation (TAVi). We examined the impact of marital status and patient sex on outcomes after TAVi. Patients who underwent TAVi from January 2015 to June 2018 were reviewed and stratified into 3 groups: single, married, and widowed.
View Article and Find Full Text PDFBackground: The "July effect", the perception of worse outcomes in the first month of training, has been previously demonstrated in critical care medicine and general surgery. However, the July effect in the context of structural heart interventions (i.e.
View Article and Find Full Text PDFBackground: The rate of chronic opioid use after cardiac surgery is high compared with other surgical specialties; however evidence regarding optimal prescribing is limited. The purpose of this study was to evaluate patterns of opioid consumption after cardiac surgery to guide prescribing practices.
Methods: Consecutive patients undergoing sternotomy-based cardiac operations were considered for enrollment.
Objective: Mitral valve replacement (MVR) in the setting of severe mitral annular calcification is a technically challenging operation with increased morbidity and mortality. Transseptal/apical transcatheter MVR (TMVR) in mitral annular calcification has emerged as an option for these cases, although may not be feasible due to anatomical reasons. Transatrial TMVR is a potential treatment option for this subgroup of patients.
View Article and Find Full Text PDFArticle Synopsis
- - The study compares outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in 69 patients who had chest radiation therapy and aortic stenosis, finding that TAVR leads to better in-hospital outcomes.
- - TAVR patients were older and had more health conditions than SAVR patients, but had a lower operative mortality rate (1.4% for TAVR vs. 4.3% for SAVR), particularly benefiting intermediate/high-risk groups.
- - The findings suggest TAVR is a safer option for high-risk patients with radiation-induced valvular disease, while SAVR may still be preferred for low-risk patients or those
Objectives: The aim of this study was to examine real-world experience with repeat transcatheter aortic valve replacement (TAVR) in a population-based national database.
Background: Repeat TAVR is a growing option in patients requiring reintervention for TAVR. However, large-scale studies with longitudinal follow-up are limited.