Hospital Volume and Long-Term Survival Among Medicare Beneficiaries Undergoing Surgical Repair of Acute Type A Aortic Dissection.

Despite guideline recommendations, transfer rates to high-volume aortic centers (high-VACs) for acute type A aortic dissections (TAAD) remain suboptimal; this may be because the benefit of undergoing surgical repair of TAAD at high-VACs remains poorly quantified. Medicare beneficiaries undergoing surgical repair of TAAD from 1999-2019 were identified. Hospital and surgeon annual aortic case volumes in Medicare beneficiaries were determined.

Institution of a formal multidisciplinary heart team for high-risk coronary revascularization.

Introduction: The heart team approach is now the standard of care for patients with complex coronary artery disease; however, the definition of a heart team is variable. We embarked on a project to create an extended, multidisciplinary heart team to evaluate patients we deemed high risk for coronary revascularization. In doing so, we created a new service, workflow, and paradigm.

SCAI Expert Consensus Statement on the Management of Patients With STEMI Referred for Primary PCI.

ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality in the United States. Timely reperfusion with primary percutaneous coronary intervention is associated with improved outcomes. The Society for Cardiovascular Angiography & Interventions puts forth this expert consensus document regarding best practices for cardiac catheterization laboratory team readiness, arterial access with an algorithm to help determine proper arterial access in STEMI, and diagnostic angiography.

Blueprint for Building and Sustaining a Cardiogenic Shock Program: Qualitative Survey of 12 US Programs.

Background: Multidisciplinary cardiogenic shock (CS) programs have been associated with improved outcomes, yet practical guidance for developing a CS program is lacking.

Methods: A survey on CS program development and operational best practices was administered to 12 institutions in diverse sociogeographic regions and practice settings. Common steps in program development were identified.

Acute mitral block: pulse field ablation plus radiofrequency ablation when compared to radiofrequency ablation plus ethanol injection of vein of Marshall.

This retrospective study evaluated two groups: patients receiving RFA for PVI, posterior wall isolation, mitral isthmus, and coronary sinus (CS) ablation with adjunctive VOM ethanol injection (VOM/RFA ALL (N = 53)), and patients receiving PVI with PFA using pentaspline catheter followed by mitral isthmus and CS ablation with RFA (PFA PV + PW/RFA MITRAL (N = 12)). We hypothesized that PFA for pulmonary vein isolation (PVI) facilitates mitral block without adjunctive vein of Marshall (VOM) ethanol injection. Mitral block was achieved in 92.

Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis.

Background: For patients with asymptomatic severe aortic stenosis and preserved left ventricular ejection fraction, current guidelines recommend routine clinical surveillance every 6 to 12 months. Data from randomized trials examining whether early intervention with transcatheter aortic-valve replacement (TAVR) will improve outcomes in these patients are lacking.

Methods: At 75 centers in the United States and Canada, we randomly assigned, in a 1:1 ratio, patients with asymptomatic severe aortic stenosis to undergo early TAVR with transfemoral placement of a balloon-expandable valve or clinical surveillance.

The use of perioperative Impella 5.5 support in high-risk cardiac surgery: a retrospective cohort study.

Background: Although the Impella device has an established role in high-risk percutaneous intervention and cardiogenic shock, its role in open cardiac surgery remains unclear. We undertook this study to better understand the role of Impella support in cardiac surgical intervention.

Methods: This is a retrospective cohort study of consecutive patients who underwent cardiac surgery with surgically placed Impella 5.

Intracardiac Echocardiography-Guided Percutaneous Mitral Balloon Commissurotomy: Technique and Early Experience.

Background: Percutaneous mitral balloon commissurotomy (PMBC) is the gold standard for the treatment of patients with symptomatic rheumatic mitral valve (MV) stenosis and favorable valve morphology. Intracardiac ultrasound (ICE)-guided PMBC is an attractive alternative to standard transesophageal echocardiography guidance for simplification of procedure and avoiding general anesthesia.

Methods: We conducted a retrospective analysis of all ICE-guided PMBC cases at our institution between July 2020 and November 2023.

Health Care Resource Utilization Following Acute Myocardial Infarction: Findings from the RECORD-MI Registry.

The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated.

Hospital and surgeon surgical valvar volume and survival after multivalve cardiac surgery in Medicare beneficiaries.

Objective: Long-term outcomes after multivalve cardiac surgery remain underevaluated.

Methods: Medicare administrative claims from 2008 to 2019 identified beneficiaries undergoing multivalve surgery. Operative characteristics were doubly adjudicated using International Classification of Diseases and Current Procedural Technology codes.

Successful open repair of syphilitic thoracoabdominal aneurysm.

Most syphilitic aneurysms involve the ascending aorta. Those involving the descending aorta are less common, and those involving the abdominal aorta are unusual. Rarer yet, we present the case of a 40-year-old man with HIV and a history of syphilis with a thoracoabdominal aneurysm.

The Promise and Perils of Transcatheter Aortic Valve Replacement (TAVR) in Low Surgical Risk Patients with Severe Aortic Stenosis in the Current Era.

Purpose Of Review: Transcatheter Aortic Valve Replacement (TAVR) has become the preferred treatment approach for many patients with symptomatic severe aortic valve stenosis (SsAS), particularly those who are deemed at high surgical risk. However, in low-risk surgical patients (LSRP) with SsAS, the choice between TAVR and surgical aortic valve replacement (SAVR) is often a matter of debate and depends on several clinical and anatomical considerations.

Recent Findings: Midterm data show similar clinical outcomes and durability of TAVR and SAVR bioprosthetic valves in LRSP.

Changes in Left Ventricular Function and Outcomes After Trancatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation.

Background: Transcatheter edge-to-edge repair (TEER) improved outcomes in patients with heart failure (HF) and severe secondary mitral regurgitation (SMR) compared with guideline-directed medical therapy (GDMT) alone regardless of the severity of baseline left ventricular ejection fraction (LVEF). The study aimed to evaluate the effect of early changes in LVEF after TEER and GDMT alone in patients with HF and severe SMR.

Methods: Within the COAPT trial, we evaluated outcomes according to changes in LVEF from baseline to 30 days.