Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block.

Patients with new-onset left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) are at risk of developing delayed high-degree atrioventricular block. Management of new-onset LBBB post-TAVI remains controversial. In the mparison of a Clinical onitoring Strategy Versus lectrophysiology-Guided Algorithmic Approach in Patients With a New LBBB After (COME-TAVI) trial, consenting patients with new-onset LBBB that persists on day 2 after TAVI, meeting exclusion/inclusion criteria, are randomized to an electrophysiological study (EPS)-guided approach or 30-day electrocardiographic monitoring.

Coronary endarterectomy in patients with diffuse coronary artery disease: assessment of graft patency with computed tomography angiography.

Background: With a growing population of patients with advanced coronary artery disease (CAD), many of whom have undergone prior percutaneous coronary interventions, coronary endarterectomy (CE) allows for the extension of revascularization in patients with otherwise limited options. Whether adjunctive CE associated with standard surgery, combined with contemporary antiplatelet therapy, improves outcomes remains largely unknown.

Methods: We studied 147 consecutive patients who underwent 154 adjunctive CE procedures for advanced CAD between January 2015 and January 2018.

Implementing Machine Learning in Interventional Cardiology: The Benefits Are Worth the Trouble.

Driven by recent innovations and technological progress, the increasing quality and amount of biomedical data coupled with the advances in computing power allowed for much progress in artificial intelligence (AI) approaches for health and biomedical research. In interventional cardiology, the hope is for AI to provide automated analysis and deeper interpretation of data from electrocardiography, computed tomography, magnetic resonance imaging, and electronic health records, among others. Furthermore, high-performance predictive models supporting decision-making hold the potential to improve safety, diagnostic and prognostic prediction in patients undergoing interventional cardiology procedures.

Use of Mobile-Based Application for Collection of Patient-Reported Outcomes in Cardiac Surgery.

Objective: Application-based (app) technology has been studied for patient engagement and collecting patient-reported outcomes (PROs) in several surgical specialties with limited research in cardiac surgery. The aim of study was to determine the effectiveness of app-based technology for collecting PROs, improving the patient experience, and reducing health services utilization in a cardiac surgery center.

Methods: Patients accessed an interactive app via smartphones.

Standardizing Postoperative Complications-Validating the Clavien-Dindo Complications Classification in Cardiac Surgery.

Cardiac surgery lacks a method for quantifying postoperative morbidities. The Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) were successfully implemented as outcome reporting methods in other surgical specialties. This study aims to validate these complication scales in cardiac surgery.

Reassessment of kidney function equations in predicting long-term survival in cardiac surgery.

Background/objectives: Chronic kidney disease (CKD) is a risk factor for long-term survival in cardiac surgery. The Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) study, CKD Epidemiology Collaboration (CKD-EPI), revised Lund-Malmö (LM), and full age spectrum equations are used to estimate glomerular filtration rates (eGFR), but each have advantages and disadvantages. Our objective was to determine which equation better predicts long-term survival.

Biomechanical characterization of a chronic type a dissected human aorta.

Aortic dissection is one of the most lethal cardiovascular diseases. A chronic Type A (Stanford) dissected aorta was retrieved for research from a 73-year-old male donor without diagnosed genetic disease. The aorta presented a dissection over the full length, and it reached a diameter of 7.

Comparison of Atrial Remodeling Caused by Sustained Atrial Flutter Versus Atrial Fibrillation.

Background: Atrial flutter (AFL) and atrial fibrillation (AF) are associated with AF-promoting atrial remodeling, but no experimental studies have addressed remodeling with sustained AFL.

Objectives: This study aimed to define the atrial remodeling caused by sustained atrial flutter (AFL) and/or atrial fibrillation (AF).

Methods: Intercaval radiofrequency lesions created a substrate for sustained isthmus-dependent AFL, confirmed by endocavity mapping.

Successful implantation of self-expanding valve for a failed stentless prosthesis.

Valve-in-valve transcatheter aortic valve implantation is currently used for failed bioprosthesis. The use of a transcatheter prosthesis in a regurgitant noncalcified root implanted Medtronic Freestyle prosthesis is particularly challenging. We present a successful transaxillary valve-in-valve implantation of a self-expandable transcatheter aortic valve prosthesis in a failed Freestyle bioprothesis implanted eleven years earlier.

Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery.

Objective: Del Nido cardioplegia solution offers prolonged cardiac protection with single-dose administration; this is particularly interesting for aortic root surgery. However, there is a scarcity of data supporting its safety in adults undergoing complex cardiac surgery, such as aortic root repair. We hypothesized that del Nido cardioplegia solution and blood cardioplegia solution provide equivalent safety during aortic root surgery.

Mid-term Outcomes in Nonelderly Adults Undergoing Surgery for Isolated Aortic Valve Infective Endocarditis: Results From Two Canadian Centers.

Background: Little is known about the mid-term prognosis of nonelderly patients (≤60 years) after the surgical treatment of isolated aortic valve infective endocarditis (IE). Better characterization of these outcomes could help in tailoring the surgical management in these patients.

Methods: From 2000 to 2015, 164 adult patients ≤60 years of age (mean 46 ± 11 years, 81% male) underwent surgical treatment for isolated aortic valve IE in 2 high-volume Canadian centers.

Surgical Turndown: "What's in a Name?" for Patients Deemed Ineligible for Surgical Revascularization.

Optimal revascularization in severe ischemic heart disease (SIHD) is addressed in all clinical guidelines. With an aging patient population, a growing challenge remains the management of patients with SIHD deemed ineligible for surgical revascularization, the so-called surgical turndown patient. The status of surgical ineligibility remains associated with worse clinical outcomes.

Impact of a tailored surgical approach on autograft root dimensions in patients undergoing the Ross procedure for aortic regurgitation†.

Objectives: The Ross procedure in patients with aortic regurgitation (AR) has been associated with increased autograft dilatation and late reintervention. The aim of this study was to evaluate the impact of a tailored approach aimed at mitigating that risk on early changes in autograft root dimensions following the Ross procedure in patients with AR.

Methods: From 2011 to 2018, 241 consecutive patients underwent a Ross procedure with >1 year of follow-up [46 (7) years].

Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the STICH Trial and a Contemporary Cohort of Patients With Left Ventricular Dysfunction Undergoing Surgical Revascularization.

Background: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting.

Dissected Aorta Repair Through Stent Implantation trial: Canadian results.

Objectives: We describe the Canadian results of the Ascyrus Medical Dissection Stent (AMDS), a novel partially uncovered aortic arch hybrid graft implanted antegrade during hypothermic circulatory arrest to promote true lumen expansion and enhance aortic remodeling.

Methods: From March 2017 to February 2018, 16 consecutive patients (66 ± 12 years; 38% female) presented with acute type A aortic dissections and underwent emergent surgical aortic repair with AMDS implantation. All patients presented with DeBakey I aortic dissection, with evidence of malperfusion in 50% (n = 8) of patients.

Expanding Eligibility for the Ross Procedure: A Reasonable Proposition?

Background: Although the Ross procedure offers potential benefits in young adults, technical complexity represents a significant limitation. Therefore, the safety of expanding its use in more complex settings is uncertain. The aim of this study was to compare early outcomes of standard isolated Ross procedures vs expanding elgibility to higher-risk clinical settings.

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy.

Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence.

Reimplantation versus remodelling with ring annuloplasty: comparison of mid-term outcomes after valve-sparing aortic root replacement.

Objectives: Remodelling with extra-aortic ring annuloplasty has emerged as an alternative approach to root reimplantation. However, no studies have yet compared outcomes between procedures. The aim of this study was to compare mid-term outcomes in patients undergoing reimplantation versus remodelling with extra-aortic annuloplasty.

Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks.

Objectives: This study sought to assess the relative merit of surgical correction (SC) versus transcatheter reduction on long-term outcomes in patients with significant paravalvular leak (PVL) refractory to medical therapy.

Background: PVL is the most frequent dysfunction following prosthetic valve replacement. Although repeat surgery is the gold standard, transcatheter reduction (TR) of PVL has been associated with reduced mortality.

Fiber-reinforced computational model of the aortic root incorporating thoracic aorta and coronary structures.

Cardiovascular diseases are still the leading causes of death in the developed world. The decline in the mortality associated with circulatory system diseases is accredited to development of new diagnostic and prognostic tools. It is well known that there is an inter relationship between the aortic valve impairment and pathologies of the aorta and coronary vessels.

Investigation on the Regional Loss Factor and Its Anisotropy for Aortic Aneurysms.

An aortic aneurysm is a lethal arterial disease that mainly occurs in the thoracic and abdominal regions of the aorta. Thoracic aortic aneurysms are prevalent in the root/ascending parts of the aorta and can lead to aortic rupture resulting in the sudden death of patients. Understanding the biomechanical and histopathological changes associated with ascending thoracic aortic aneurysms (ATAAs), this study investigates the mechanical properties of the aorta during strip-biaxial tensile cycles.