Clinical Outcomes and Costs of Robotic-assisted vs Conventional Mitral Valve Repair: A National Analysis.

Background: Robotic approaches have been increasingly utilized for cardiothoracic operations, though concerns regarding costs remain. We evaluated short-term outcomes and costs of robotic-assisted and conventional mitral valve repair (MV-repair), hypothesizing that cost differences would be mitigated at high-volume programs.

Methods: Adults undergoing elective MV-repair from 2016 to 2020 were identified in the Nationwide Readmissions Database.

Decreased Left Atrial Cardiomyocyte FGF13 Expression Increases Vulnerability to Postoperative Atrial Fibrillation in Humans.

Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and a significant cause of increased morbidity and mortality. The development of novel POAF therapeutics has been limited by an insufficient understanding of molecular mechanisms promoting atrial fibrillation. In this observational cohort study, we enrolled 28 patients without a history of atrial fibrillation that underwent mitral valve surgery for degenerative mitral regurgitation and obtained left atrial tissue samples along the standard atriotomy incision in proximity to the right pulmonary veins.

Volume-outcome relationship in septal myectomy for hypertrophic obstructive cardiomyopathy.

Background: Septal myectomy is the gold standard treatment for refractory hypertrophic obstructive cardiomyopathy. The present study characterized the association of septal myectomy volume and cardiac surgery volume with outcomes after septal myectomy.

Methods: Adults undergoing septal myectomy for hypertrophic obstructive cardiomyopathy were identified in the 2016 to 2019 Nationwide Readmissions Database.

Left atrial appendage closure during cardiac surgery: Safe but underutilized in California.

Objective: Left atrial appendage (LAA) closure is associated with reduced rates of stroke in patients with atrial fibrillation (AF). We evaluated trends in LAA closure, the association of LAA closure with stroke/systemic embolism, and its safety profile in patients with AF who underwent cardiac surgery in California. We further tested for hospital-level variation in concomitant LAA closure.

The Impact of COVID-19 on Racial and Ethnic Disparities in Cardiac Procedural Care.

Objective: The primary objective of this study was to evaluate whether the COVID-19 pandemic altered the racial and ethnic composition of patients receiving cardiac procedural care.

Design: This was a retrospective observational study.

Setting: This study was conducted at a single tertiary-care university hospital.

An Unusual Case of Left Ventricular Outflow Tract Pseudoaneurysm.

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare condition with a wide range of causes and various clinical outcomes. The causes range from infections, trauma to the chest wall, and iatrogenic origins. We present a unique case of idiopathic LVOT pseudoaneurysm in a patient with no obvious clinical risk factors.

Transcatheter Aortic Valve Replacement for Severe Aortic Valve Stenosis: Do Patients Experience Better Quality of Life Regardless of Gradient?

Background: Aortic valve replacement improves survival for patients with low-gradient aortic valve stenosis, but there is a paucity of data on postoperative quality of life for this population.

Methods: In a single-center retrospective analysis of 304 patients with severe aortic valve stenosis who underwent transcatheter aortic valve replacement, patients were divided into 4 groups based on mean pressure gradient, left ventricular ejection fraction, and stroke volume index. Using the Kansas City Cardiomyopathy Questionnaire-12, quality of life was assessed immediately before and 1 month after transcatheter aortic valve replacement.

Outcomes of heart transplant recipients bridged with percutaneous versus durable left ventricular assist devices.

Background: The new United Network for Organ Sharing (UNOS) heart allocation policy prioritizes temporary percutaneous over durable left ventricular assist devices (LVAD) as bridge to transplant. We sought to examine 1-year outcomes of heart transplant recipients bridged with Impella versus durable LVADs.

Methods: All primary adult orthotopic heart transplant recipients registered in UNOS between January 2016 and June 2021 were analyzed.

Longitudinal profiling in patients undergoing cardiac surgery reveals postoperative changes in DNA methylation.

Background: Cardiac surgery and cardiopulmonary bypass induce a substantial immune and inflammatory response, the overactivation of which is associated with significant pulmonary, cardiovascular, and neurologic complications. Commensurate with the immune and inflammatory response are changes in the heart and vasculature itself, which together drive postoperative complications through mechanisms that are poorly understood. Longitudinal DNA methylation profiling has the potential to identify changes in gene regulatory mechanisms that are secondary to surgery and to identify molecular processes that predict and/or cause postoperative complications.

Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery.

Objective: To characterize the impact of pulmonary complications (PCs) on mortality, costs, and readmissions after elective cardiac operations in a national cohort and to test for hospital-level variation in PC.

Background: PC after cardiac surgery are targets for quality improvement efforts. Contemporary studies evaluating the impact of PC on outcomes are lacking, as is data regarding hospital-level variation in the incidence of PC.

Morbidity and Mortality Associated With Blood Transfusions in Elective Adult Cardiac Surgery.

Objectives: Perioperative transfusion thresholds have garnered increasing scrutiny as restrictive strategies have been shown to be noninferior. The study authors used data from a statewide academic collaborative to test the association between transfusion and 30-day mortality.

Design: All adult patients undergoing coronary artery bypass grafting (CABG) and/or valve surgeries between 2013 and 2019 in the authors' Academic Cardiac Surgery Consortium were examined.

Parsimonious machine learning models to predict resource use in cardiac surgery across a statewide collaborative.

Objective: We sought to several develop parsimonious machine learning models to predict resource utilization and clinical outcomes following cardiac operations using only preoperative factors.

Methods: All patients undergoing coronary artery bypass grafting and/or valve operations were identified in the 2015-2021 University of California Cardiac Surgery Consortium repository. The primary end point of the study was length of stay (LOS).

Influence of center surgical aortic valve volume on outcomes of transcatheter aortic valve replacement.

Objective: The utilization of transcatheter aortic valve replacement (TAVR) technology has exceeded that of traditional surgical aortic valve replacement (SAVR). In addition, the role of minimum surgical volume requirements for TAVR centers has recently been disputed. The present work evaluated the association of annual institutional SAVR caseload on outcomes following TAVR.

Regional Variation in the Use and Outcomes of Transcatheter Aortic Valve Replacement in California.

Background: Transcatheter aortic valve replacement (TAVR) has been widely adopted for management of aortic stenosis. The purpose of this study was to examine regional access to and outcomes following TAVR in California.

Methods: Patients undergoing TAVR or isolated surgical aortic valve replacement (SAVR) from 2008 to 2019 in California were identified in the Office of Statewide Health Planning and Development database.

Defining value in cardiac surgery: A contemporary analysis of cost variation across the United States.

Objective: Isolated coronary artery bypass grafting and aortic valve replacement are common cardiac operations performed in the United States and serve as platforms for benchmarking. The present national study characterized hospital-level variation in costs and value for coronary artery bypass grafting and aortic valve replacement.

Methods: Adults undergoing elective, isolated coronary artery bypass grafting or aortic valve replacement were identified in the 2016-2018 Nationwide Readmissions Database.

Staged versus concomitant transcatheter aortic valve replacement and percutaneous coronary intervention: A national analysis.

Objective: Although patients with significant coronary artery disease and aortic stenosis have traditionally undergone open valve replacement and bypass grafting, percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are increasingly considered. Because of the lack of data regarding timing of PCI/TAVR, in the present study we evaluated associations of staged and concomitant PCI/TAVR on outcomes in a nationally representative cohort.

Methods: Adults who underwent TAVR and PCI were identified using the 2016 to 2018 Nationwide Readmissions Database.

Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel.

Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on >50 years experience, surgery reliably reverses disabling heart failure by permanently abolishing mechanical outflow impedance and mitral regurgitation, with normalization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increasing significantly in number over the most recent 15 years.

Transcatheter and Surgical Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Stenosis.

Background: Transcatheter aortic valve replacement (TAVR) is not widely used in patients with bicuspid aortic valve (BAV) disease and has not yet been studied in randomized clinical trials. We characterized the rate of use and outcomes of TAVR and surgical aortic valve replacement (SAVR) in patients with BAV.

Methods: Adults with BAV stenosis receiving SAVR or TAVR procedures were abstracted from the 2012 to 2019 Nationwide Readmissions Database (NRD).

DNA Methylation-Based Prediction of Post-operative Atrial Fibrillation.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and post-operative atrial fibrillation (POAF) is a major healthcare burden, contributing to an increased risk of stroke, kidney failure, heart attack and death. Genetic studies have identified associations with AF, but no molecular diagnostic exists to predict POAF based on pre-operative measurements. Such a tool would be of great value for perioperative planning to improve patient care and reduce healthcare costs.

Implementation and outcomes of an urban mobile adult extracorporeal life support program.

Objective: Although extracorporeal life support (ECLS) has been increasingly adopted as rescue therapy for cardiac and pulmonary failure, it remains limited to specialized centers. The present study reports our institutional experience with mobile ECLS across broad indications, including postcardiotomy syndrome, cardiogenic shock, and COVID-19 acute respiratory failure.

Methods: We performed a retrospective review of all patients transported to our institution through our mobile ECLS program from January 1, 2018, to January 15, 2021.

Timing of Coronary Artery Bypass Grafting in Acute Coronary Syndrome: A National Analysis.

Background: Timing of surgical revascularization for acute coronary syndrome remains debated. We assessed the impact of timing to coronary artery bypass grafting (CABG) on mortality and resource utilization in a national cohort.

Methods: Adults admitted for acute coronary syndrome in the 2009-2018 National Inpatient Sample were grouped by time from coronary angiography to CABG (Δt): 0, 1-3, 4-7, and >7 days.

Validity of echocardiography for detection of left ventricular thrombus with surgical validation in patients awaiting durable left ventricular assist device.

Objective: Unrecognized left ventricular thrombi (LVT) can have devastating clinical implications and precludes patients with end-stage heart failure from undergoing left ventricular assist device (LVAD) implantation without cardiopulmonary bypass assistance. We assessed the reliability of an echocardiogram to diagnose LVT in patients with end-stage heart disease who underwent LVAD implantation.

Methods: A single-center retrospective study evaluated 232 consecutive adult patients requiring implantation of durable LVADs between 2005 and 2019.