High Risk of Prosthetic Valve Endocarditis and Death After Valve Replacement Operations in Dialysis Patients.

Background: Despite a high burden of dialysis access-related bloodstream infections and an increasing incidence of endocarditis, few data are available addressing the risk of prosthetic valve endocarditis (PVE) in the dialysis population. We sought to assess the risk of PVE and death after valve replacement operations in patients receiving long-term dialysis.

Methods: A matched retrospective cohort study was conducted comprising patients admitted for valve replacement operations at two university hospitals.

Multidrug-Resistant Organism Infections in Patients with Left Ventricular Assist Devices.

Left ventricular assist devices improve survival prospects in patients with end-stage heart failure; however, infection complicates up to 59% of implantation cases. How many of these infections are caused by multidrug-resistant organisms is unknown. We sought to identify the incidence, risk factors, and outcomes of multidrug-resistant organism infection in patients who have left ventricular assist devices.

Outcomes for Transcatheter Aortic Valve Replacement in Nonagenarians.

Background: Transcatheter aortic valve replacement (TAVR) may offer extreme-aged patients a treatment alternative to surgical aortic valve replacement (SAVR). The objective of this study was to describe outcomes of TAVR in nonagenarians using transfemoral and alternative access techniques.

Methods: In a retrospective review, we found 95 nonagenarians who underwent TAVR from September 2007 through February 2014 at Emory University using a balloon expandable valve: transfemoral (n = 66), transapical (n = 14), transaortic (n = 14), and transcarotid (n = 1).

Prospective Evaluation of Weight-Based Prophylactic Enoxaparin Dosing in Critically Ill Trauma Patients: Adequacy of AntiXa Levels Is Improved.

Venous thromboembolism (VTE) is a leading cause of death in multisystem trauma patients; the importance of VTE prevention is well recognized. Presently, standard dose enoxaparin (30 mg BID) is used as chemical prophylaxis, regardless of weight or physiologic status. However, evidence suggests decreased bioavailability of enoxaparin in critically ill patients.

High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques.

Background: Patient characteristics and procedural outcomes from nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) in high-risk or inoperable patients with aortic stenosis have been incompletely reported. The purpose of this study was to compare outcomes with non-TF TAVR access techniques including transapical (TA), transaortic (TAo), and transcarotid (TC) TAVR with a balloon-expandable valve.

Methods: A retrospective review was performed of all patients undergoing TA, TAo, and TC TAVR from 2007 to 2013 at Emory University.

Avoiding aortic clamping during coronary artery bypass grafting reduces postoperative stroke.

Objective: The purpose of this study was to determine whether the incidence of postoperative stroke could be reduced by eliminating aortic clamping during coronary artery bypass grafting.

Methods: From 2002 to 2013, 12,079 patients underwent primary, isolated coronary artery bypass grafting at a single US academic institution. Aortic manipulation was completely avoided by using in situ internal thoracic arteries for inflow in 1552 patients (12.

Transcatheter aortic valve replacement has improved short-term but similar midterm outcomes in isolated aortic valve replacement after prior coronary artery bypass grafting.

Background: An increasing number of patients with prior coronary artery bypass grafting (CABG) now present with severe aortic stenosis. The proposed benefit of surgical (SAVR) vs transcatheter aortic valve replacement (TAVR) is unknown. The objective of this study was to compare short-term and midterm outcomes of patients undergoing isolated SAVR vs TAVR in those with prior CABG.

Reduced intraocular pressure after cataract surgery in patients with narrow angles and chronic angle-closure glaucoma.

Purpose: To evaluate the effect of cataract surgery on intraocular pressure (IOP) in patients with narrow angles and chronic angle-closure glaucoma (ACG) and to determine whether the change in IOP was correlated with the preoperative pressure, axial length (AL), and anterior chamber depth (ACD).

Setting: Private practice, Atlanta, Georgia, USA.

Design: Retrospective case series.

Intrapyloric botulinum injection increases postoperative esophagectomy complications.

Background: Intrapyloric botulinum toxin injection has emerged as a possible alternative to standard pyloric drainage procedures. Possible advantages include decreased operative time and less postoperative dumping and bile reflux symptoms. However, data are lacking to show its effectiveness versus standard drainage procedures.

Incidence of postoperative stroke using the Heartstring device in 1,380 coronary artery bypass graft patients with mild to severe atherosclerosis of the ascending aorta.

Background: Atherosclerotic disease of the ascending aorta during coronary artery bypass graft surgery (CABG) increases the risk for postoperative stroke. The objective of this study was to examine the incidence of postoperative stroke in CABG utilizing the Heartstring (Maquet Cardiovascular, San Jose, CA) proximal anastomotic device.

Methods: Intraoperative epiaortic ultrasonography was used to grade atherosclerosis in CABG patients at Emory University from April 2003 to December 2012.

The impact of clopidogrel therapy on postoperative bleeding after robotic-assisted coronary artery bypass surgery.

Objectives: The purpose of this study was to determine whether patients undergoing robotic-assisted coronary artery bypass graft surgery (CABG) on clopidogrel had an increased risk of bleeding complications compared with those not on clopidogrel.

Methods: From 2008 to 2011, 322 patients underwent robotic-assisted CABG either as an isolated procedure or as part of a hybrid coronary revascularization procedure (HCR). Patients were classified according to whether they received clopidogrel within 5 days of surgery or intraoperatively (n = 64) compared with those who never received or who had discontinued clopidogrel therapy >5 days before surgery (n = 258).

Comparison of injury mortality risk in motor vehicle crash versus other etiologies.

The mortality risk ratio (MRR), a measure of the proportion of people who died that sustained a given injury, is reported to be among the most powerful discriminators of mortality following trauma. The primary aim was to determine whether mechanistic differences exist and are quantifiable when comparing MRR-based injury severity across two broadly defined etiologies (motor vehicle crash (MVC) versus non-MVC) for the clarification of important injury types that have some room for improvement by emergency treatment and vehicle design. All International Classification of Diseases, 9th revision (ICD-9) coded injuries in the National Trauma Data Bank (NTDB) database were stratified into MVC and non-MVC groups and the MRR for each injury was computed within each group.

The impact of hybrid coronary revascularization on hospital costs and reimbursements.

Background: Hybrid coronary revascularization (HCR) combines a minimally invasive, left internal mammary artery-left anterior descending coronary artery (LAD) bypass with percutaneous intervention of non-LAD vessels for patients with multivessel coronary disease. The financial implications of HCR have not been compared with off-pump coronary artery bypass (OPCAB) through sternotomy.

Methods: The contribution margin is a fiduciary calculation (best hospital payment estimate--total variable costs) used by hospitals to determine fiscal viability of services.

Total arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion.

Objective: To examine the clinical outcomes and impact of using moderate hypothermic circulatory arrest (MHCA) and unilateral selective antegrade cerebral perfusion (uSACP) in the setting of total aortic arch replacement (TOTAL).

Methods: From 2004 to 2012, 733 patients underwent open arch reconstruction with MHCA and SACP. Of these, 145 (20%) underwent TOTAL.

Mortality-based Quantification of Injury Severity for Frequently Occurring Motor Vehicle Crash Injuries.

The study purpose was to develop mortality-based metrics of injury severity for frequent motor vehicle crash (MVC) injuries. Injury severity was quantified with mortality-based metrics for 240 injuries comprising the top 95% most frequently occurring AIS 2+ injuries in the National Automotive Sampling System - Crashworthiness Data System (NASS-CDS) 2000-2011. Mortality risk ratios (MRRs) were computed by dividing the number of deaths by occurrences for each of the 240 injuries using National Trauma Data Bank Research Data System (NTDB-RDS) MVC cases.

Postoperative warfarin following mitral valve repair or bioprosthetic valve replacement.

Background And Aim Of The Study: Short-term postoperative warfarin therapy has been used to decrease neurologic events following mitral valve repair or bioprosthetic replacement (MVR). The study aim was to compare the short- and long-term outcomes of patients undergoing mitral valve surgery with or without short-term postoperative warfarin.

Methods: A single academic US institution retrospective review was performed on discharged patients who underwent MVR between January 1996 and March 2010.

The accuracy of transit time flow measurement in predicting graft patency after coronary artery bypass grafting.

Objective: Transit time flow measurement (TTFM) is a method used to assess intraoperative blood flow after vascular anastomoses. Angiography represents the criterion standard for the assessment of graft patency after coronary artery bypass grafting (CABG). The purpose of this study was to compare flow measurements from TTFM to diagnostic angiography.

Long-term survival for patients with metabolic syndrome after bioprosthetic or mechanical valve replacement.

Background: Metabolic diseases are thought to negatively impact the long-term survival of cardiac patients and have been shown to be associated with reduced durability of bioprosthetic heart valves. The purpose of this study is to determine whether long-term survival of post-valve replacement patients is affected by the presence of metabolic disease, and whether choice of tissue versus mechanical prosthesis impacts survival.

Methods: A retrospective review was conducted of all isolated valve replacements performed between 2002 and 2011 from the STS adult cardiac database of Emory Healthcare Hospitals.

Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement.

Background: Renal impairment portends adverse outcomes in patients undergoing valvular heart surgery. The relationship between renal dysfunction in patients undergoing transcatheter aortic valve replacement (TAVR) is incompletely understood.

Methods: A retrospective review of 1336 patients undergoing surgical aortic valve replacement (SAVR; 2002-2012) and 321 patients undergoing TAVR (2007-2012) was performed.

Improved left ventricular function and remodeling after the david v for significant aortic insufficiency.

Background: Valve-sparing root replacement is controversial in patients with significant aortic insufficiency (AI) because the aortic valve cusps often require repair, which may potentially jeopardize long-term valve function. The purpose of this study was to evaluate valve function and left ventricular reverse remodeling in patients undergoing valve-sparing root replacement in the setting of significant AI.

Methods: A review of the Emory Aortic Surgery database between 2004 and 2012 identified 616 aortic root replacements.

Acute type a dissection: impact of antegrade cerebral perfusion under moderate hypothermia.

Background: The optimal method of arterial cannulation and circulation management for acute type A aortic dissection (type A) remains debated. Moderate hypothermic circulatory arrest (MHCA) and unilateral selective antegrade cerebral perfusion (uSACP) is effective in the elective setting. In this study, the impact of MHCA and uSACP on outcomes for type A repair was evaluated.

Use of transaortic, transapical, and transcarotid transcatheter aortic valve replacement in inoperable patients.

Background: Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with severe aortic stenosis unsuitable for surgical aortic valve replacement (SAVR). This study evaluated the early experience with the posttrial application of TAVR, with specific focus on non-transfemoral (TF) access.

Methods: All patients who underwent posttrial TAVR at Emory University from November 2011 to April 2012 were reviewed.

Impact of preoperative chronic lung disease on survival after surgical aortic valve replacement.

Background: An increasing number of patients requiring surgical aortic valve replacement (SAVR) present with chronic pulmonary obstructive disease (COPD). The purpose of this study was to compare patients who had a range of COPD from normal to severe and were undergoing SAVR.

Methods: Retrospective review of 2,379 patients undergoing SAVR ± coronary artery bypass grafting (CABG) from January 2002 to April 2012 at a US academic institution was performed.

Trends in aortic clamp use during coronary artery bypass surgery: effect of aortic clamping strategies on neurologic outcomes.

Objective: The purpose of the present study was to determine the effect of different clamping strategies during coronary artery bypass grafting on the incidence of postoperative stroke.

Methods: In the present case-control study, all patients at Emory hospitals from 2002 to 2009 with postoperative stroke after isolated coronary artery bypass grafting (n = 141) were matched 1:4 to a contemporaneous cohort of patients without postoperative stroke (n = 565). The patients were matched according to the Society of Thoracic Surgeons' predicted risk of postoperative stroke score, which is based on 26 variables.

The impact of specific preoperative organ dysfunction in patients undergoing aortic valve replacement.

Background: Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes.