Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial.

Objective: To compare program adherence and functional capacity between women referred to supervised mixed-sex, supervised women-only, or home-based cardiac rehabilitation (CR).

Patients And Methods: Cardiac Rehabilitation for Heart Event Recovery (CR4HER) was a single-blind, 3 parallel-arm, pragmatic randomized controlled trial. The study took place between November 1, 2009, and July 31, 2013.

Women's preferences for cardiac rehabilitation program model: a randomized controlled trial.

Background: Although cardiac rehabilitation (CR) is effective, women often report programs do not meet their needs. Innovative models have been developed that may better suit women. The objectives of the study were to describe: (1) adherence to CR model allocation; (2) satisfaction by model attended; and (3) CR preferences.

Repair of aorto-left ventricular and aorto-right ventricular fistulas following prosthetic valve endocarditis.

We report a case of a 77-year-old male who presented with an aorto-left ventricular fistula and an aorto-right ventricular fistula secondary to prosthetic valve endocarditis.

Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study.

Background: Despite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED).In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts.

Improving results for coronary artery bypass graft surgery in the elderly.

Objectives: The proportion of elderly patients undergoing isolated coronary artery bypass grafting (CABG) surgery has steadily increased. We have evaluated temporal trends in hospital outcomes of patients who were 75 years and older undergoing CABG (1990-2010) at our institution.

Methods: Data were collected prospectively for 3483 consecutive patients who were 75 years and older (median 78 years; range 75-94) undergoing isolated CABG at our institution over three time cohorts: 1990-96 (n = 817), 1997-2003 (n = 1534) and 2004-10 (n = 1132).

Psychometric validation of the cardiac rehabilitation barriers scale.

Objective: The purpose of this study was to investigate the factor structure and psychometric properties of the Cardiac Rehabilitation Barriers Scale (CRBS).

Design, Setting, And Participants: In total, 2636 cardiac inpatients from 11 hospitals completed a survey. One year later, participants completed a follow-up survey, which included the CRBS.

Changing pattern of reoperative coronary artery bypass grafting: a 20-year study.

Background: Fewer patients are undergoing reoperative coronary artery bypass grafting (CABG). We investigated the prevalence of redo vs primary CABG and previous percutaneous coronary intervention (PCI), changing trends in preoperative risk profiles, and independent predictors of operative death.

Methods: Data on demographic characteristics, preoperative risk factors, and hospital outcomes were collected prospectively for patients undergoing isolated reoperative CABG from January 1, 1990, to December 31, 2009.

Surgical management of a left anterior descending pseudoaneurysm related to Behcet's disease.

A 22-year-old woman suffering from Behcet's disease and severe angina was diagnosed with a left anterior descending coronary artery giant pseudoaneurysm. Preoperative investigations, surgical management, and its principles, as well as specific postoperative follow-up considerations are described.

Changing trends in emergency coronary bypass surgery.

Background: Patients undergoing emergency coronary artery bypass grafting represent a unique and high-risk population that remains challenging for cardiac surgeons. We examined the changing trends in patients undergoing emergency bypass grafting over the past 20 years.

Methods: We conducted a retrospective review of our database between 1990 and 2009 and patients were divided into 2 groups based on year of operation: 1990-1999, n = 393; 2000-2009, n = 184.

Persistent left ventricular false aneurysm after transapical insertion of an aortic valve.

Transcatheter aortic valve implantation (TAVI), via either a femoral or apical approach, has been developed as an alternative to conventional aortic valve replacement for patients whose operative risks are considered too high for conventional surgery. Complications with these relatively new procedures are being reported with increasing frequency. We report a case of transapical TAVI, in which the patient developed a false aneurysm at the apex of the left ventricle as a complication of the procedure.

A giant cavernous hemangioma of the heart.

Cardiac hemangiomas are exceptionally rare, vascular neoplasms of the heart, with an incidence of 1% to 2% among all detected benign heart tumors. With the availability of the advanced imaging modalities of the heart, asymptomatic cardiac tumors are detected more frequently. These tumors are composed either of capillaries or larger cavernous channels.

Dual antiplatelet therapy in patients requiring urgent coronary artery bypass grafting surgery: a position statement of the Canadian Cardiovascular Society.

Unlabelled: Acute coronary syndrome (ACS) guidelines recommend that most patients receive dual antiplatelet therapy with clopidogrel and acetylsalicylic acid (ASA) at the time of presentation to prevent recurrent ischemic events. Approximately 10% of ACS patients require coronary artery bypass grafting surgery (CABG) during the index admission. Most studies show that patients who receive ASA and clopidogrel within five days of CABG have an increase in operative bleeding.

The successful management of severe protamine-induced pulmonary hypertension using inhaled prostacyclin.

Acute pulmonary hypertension is a severe and life-threatening reaction that rarely occurs secondary to protamine administration. Management of systemic hypotension combined with severe pulmonary hypertension causing right ventricular failure is challenging. We describe a case of acute pulmonary hypertension induced by protamine during elective coronary artery bypass surgery refractory to multiple systemic inotropic and vasopressor therapies.

Decreasing mortality for coronary artery bypass surgery in octogenarians.

Background: Octogenarians are the fastest growing population in Canada and have also been referred for coronary artery bypass grafting (CABG) with increasing frequency during the past decade.

Objective: To examine the changing trends in preoperative risk profiles, postoperative outcomes and hospital resource use in the octogenarian population.

Methods: A retrospective review was conducted to identify all patients 80 years of age or older who underwent isolated CABG at the Toronto General Hospital (Toronto, Ontario) between 1990 and June 2005.

Degree and correlates of cardiac knowledge and awareness among cardiac inpatients.

Objective: To investigate the degree of CHD awareness as well as symptom, risk factor, and treatment knowledge in a broad sample of cardiac inpatients, and to examine its sociodemographic, clinical and psychosocial correlates.

Methods: 1308 CHD inpatients (351 [27.0%] female), recruited from 11 acute care sites in Ontario, participated in this cross-sectional study.

Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis.

Objective: To determine if there is a relation between aspirin "resistance" and clinical outcomes in patients with cardiovascular disease.

Design: Systematic review and meta-analysis.

Data Source: Electronic literature search without language restrictions of four databases and hand search of bibliographies for other relevant articles.

Thoracic complications of nasogastric tube: review of safe practice.

Objectives: Insertion of a nasogastric tube, though a common clinical procedure, can produce unexpected complications. We sought to analyse the procedure, and explore means to improve its safety.

Methods: We present a case with a thoracic complication.

Ethnic diversity: South Asian ethnicity is associated with increased coronary artery bypass grafting mortality.

Objective: South Asian ethnicity might result in a higher atherosclerotic vascular risk compared with white ethnicity. However, the effect of South Asian ethnicity on clinical outcomes after cardiac surgery is unknown. Thus, we determined whether South Asian ethnicity is a predictor of a poorer outcome after coronary artery bypass grafting.

Development and validation of Transfusion Risk Understanding Scoring Tool (TRUST) to stratify cardiac surgery patients according to their blood transfusion needs.

Background: Allogeneic blood transfusion is associated with transfusion reactions, infection transmission, and postoperative morbidity and mortality. The objective of this study was to develop and validate an accurate and simple clinical index to stratify cardiac surgery patients according to their blood transfusion needs.

Methods And Results: Data on consecutive adult patients who underwent cardiac surgery at Toronto General Hospital (n = 11,113) and Sunnybrook and Women's College Health Sciences Center (n = 5316) between May 1999 and June 2004 were collected for the development, validation, and external validation of the index.

Does the use of erythropoietin reduce the risk of exposure to allogeneic blood transfusion in cardiac surgery? A systematic review and meta-analysis.

Background: The use of blood conservation techniques is important in cardiac surgery as postoperative bleeding is common and allogeneic blood transfusion carries the risk of transfusion reactions and infection transmission. Erythropoietin with and without preoperative autologous blood donation is one of the modalities to avoid allogeneic blood transfusion. The objective of this review was to assess the effectiveness of erythropoietin in reducing the risk of exposure to allogeneic blood transfusion during or after cardiac surgery.