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1.
Eric Siskind Leo Amodu Chang Liu Meredith Akerman Joshua Stodghill Ravinder Wali James Piper Johann Jonsson Ernesto Molmenti Jorge Ortiz 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):195-203
Background
The decision to utilize portal or systemic venous drainage in pancreas transplantation is surgeon- and center-dependent. Information regarding the superior method is based on single-center reports and animal models.Methods
UNOS data on adults receiving pancreas and kidney-pancreas transplants from 1987 to 2016 were analyzed (n = 29 078). The groups analyzed were: systemic venous pancreas graft drainage (SVD, n = 24 512) or portal venous pancreas graft drainage (PVD, n = 4566). A Cox proportional hazard model compared patient and allograft survival between groups.Results
No statistically significant differences were observed for patient and allograft survival at 1, 3, 5, 10, or 15 years post-transplant at each time interval and cumulatively (patient – HR:1.041; 95% CI:0.989–1.095; allograft – HR:0.951; 95% CI:0.881–1.027). PVD reduced the risk of death by 22.0% (P = 0.017) compared to SVD for patients undergoing pancreas after kidney transplant (PAK); no statistically significant difference was found for patients undergoing other types of transplants.Conclusion
There is no significant clinical difference in patient or allograft survival between PVD and SVD in pancreas transplantation for the majority of patients. For the subgroup of PAK, PVD was associated with decreased mortality. For individual surgeons, center and patient scenarios should dictate which technique is performed. 相似文献2.
Nicole Ata Subhashini Ayloo Alan Tsung Michele Molinari 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):67-76
Background
The oncological effects of obesity on liver transplant (LT) patients with hepatocellular carcinoma (HCC) remains unclear. We investigated patient overall survival and tested two-way interactions between donor and recipient obesity status.Methods
Using the UNOS database, a total of 8352 LT recipients with HCC were included. Donors and recipients were stratified in normal weight (NW), overweight (OW) and obese (OB). Hazard ratios (HR) for any cause of death and interactions between recipient and donor BMI were estimated by multivariate flexible parametric models.Results
Five-year overall survival was 66% for NW, 67% for OW and 68% for OB recipients. The HRs of death from all causes were 0.96 (95% CI: 0.86–1.08) for OW and 0.93 (95% CI: 0.82–1.05) for OB recipients when compared to NW patients. At multivariate analysis, predictors of inferior survival were recipient age (≥65 years), donor age (≥45 years), need for pre-operative dialysis, HCV infection, transplants performed before 2007, and UNOS regions 2,3,9,10, and 11. The lowest adjusted HR was measured for recipients with BMI between 25 and 35 and there were no interactions between recipient and donor BMI.Conclusions
the overall survival of LT recipients with HCC was not affected by donor or recipient obesity. 相似文献3.
Ekaterina Petrova Hryhoriy Lapshyn Dirk Bausch Jan D&#x;Haese Jens Werner Thomas Klier Natascha C. Nüssler Jochen Gaedcke Michael Ghadimi Waldemar Uhl Orlin Belyaev Olga Kantor Marshall Baker Tobias Keck Ulrich F. Wellner 《Pancreatology》2019,19(1):17-25
Background
Postoperative pancreatic fistula (POPF) is a major factor for morbidity and mortality after pancreatic resection. Risk stratification for POPF is important for adjustment of treatment, selection of target groups in trials and quality assessment in pancreatic surgery. In this study, we built a risk-prediction model for POPF based on a large number of predictor variables from the German pancreatic surgery registry StuDoQ|Pancreas.Methods
StuDoQ|Pancreas was searched for patients, who underwent pancreatoduodenectomy from 2014 to 2016. A multivariable logistic regression model with elastic net regularization was built including 66 preoperative und intraoperative parameters. Cross-validation was used to select the optimal model. The model was assessed via area under the ROC curve (AUC) and calibration slope and intercept.Results
A total of N?=?2488 patients were included. In the optimal model the predictors selected were texture of the pancreatic parenchyma (soft versus hard), body mass index, histological diagnosis pancreatic ductal adenocarcinoma and operation time. The AUC was 0.70 (95% CI 0.69–0.70), the calibration slope 1.67 and intercept 1.12. In the validation set the AUC was 0.65 (95% CI 0.64–0.66), calibration slope and intercept were 1.22 and 0.42, respectively.Conclusion
The model we present is a valid measurement instrument for POPF risk based on four predictor variables. It can be applied in clinical practice as well as for risk-adjustment in research studies and quality assurance in surgery. 相似文献4.
Pim B. Olthof Mamoru Miyasaka Bas Groot Koerkamp Jimme K. Wiggers William R. Jarnagin Takehiro Noji Satoshi Hirano Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):345-351
Background
Perihilar cholangiocarcinoma (PHC) often requires extensive surgery which is associated with substantial morbidity and mortality. This study aimed to compare an Eastern and Western PHC cohort in terms of patient characteristics, treatment strategies and outcomes including a propensity score matched analysis.Methods
All consecutive patients who underwent combined biliary and liver resection for PHC between 2005 and 2016 at two Western and one Eastern center were included. The overall perioperative and long-term outcomes of the cohorts were compared and a propensity score matched analysis was performed to compare perioperative outcomes.Results
A total of 210 Western patients were compared to 164 Eastern patients. Western patients had inferior survival compared to the East (hazard-ratio 1.72 (1-23-2.40) P < 0.001) corrected for age, ASA score, tumor stage and margin status. After propensity score matching, liver failure rate, morbidity, and mortality were similar. There was more biliary leakage (38% versus 13%, p = 0.015) in the West.Conclusion
There were major differences in patient characteristics, treatment strategies, perioperative outcomes and survival between Eastern and Western PHC cohorts. Future studies should focus whether these findings are due to the differences in the treatment or the disease itself. 相似文献5.
Amanda P.C.S. Boteon Yuri L. Boteon James Hodson Helen Osborne John Isaac Ravi Marudanayagam Darius F. Mirza Paolo Muiesan John K. Roberts Robert P. Sutcliffe 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):26-33
Background
Unplanned hospital readmission after pancreaticoduodenectomy (PD) is usually due to surgical complications and has significant clinical and economic impact. This study developed a risk score to predict 30-day readmission after PD.Methods
Patients undergoing PD between 2009 and 2016 were reviewed from a prospective database. Predictors of readmission were identified using a multivariable logistic regression model, from which a points-based risk scoring system was derived.Results
81 of 518 patients (15.6%) were readmitted within 30 days. History of cardiac disease ([odds ratio] OR = 2.12; 95% CI: 1.12–4.56), CRP>140 mg/L on post-operative day 3 (OR = 2.34; 95% CI: 1.37–4.35) and comprehensive complication index >14 (OR = 1.74; 95% CI: 1.03–2.85) were independent predictors of readmission. The regression coefficients were used to generate a risk score with excellent calibration (p = 0.917) and good discrimination (c-index = 0.65; 95% CI: 0.58–0.71; p < 0.001). Patients were categorised as low, moderate and high risk, with readmission rates of 6.4%, 13.4% and 23.0% respectively (p < 0.001).Conclusion
The risk score identifies patients at high risk of readmission after pancreaticoduodenectomy. Such patients may benefit from pre-discharge imaging and/or enhanced follow-up, which may potentially reduce the impact of readmissions. 相似文献6.
Juan J. Russo Natasha Aleksova Ian Pitcher Etienne Couture Simon Parlow Mohammad Faraz Sarah Visintini Trevor Simard Pietro Di Santo Rebecca Mathew Derek Y. So Koji Takeda A. Reshad Garan Dimitrios Karmpaliotis Hiroo Takayama Ajay J. Kirtane Benjamin Hibbert 《Journal of the American College of Cardiology》2019,73(6):654-662
Background
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a widely used form of mechanical circulatory support in patients with refractory cardiogenic shock. A common drawback of this modality is a resultant increase in left ventricular afterload.Objectives
The purpose of this meta-analysis was to examine the efficacy and safety of left ventricular unloading strategies during VA-ECMO in adult patients with cardiogenic shock.Methods
The authors performed a systematic search of studies examining left ventricular unloading during VA-ECMO in Medline, EMBASE, and the Cochrane library. The primary outcome was all-cause mortality. Secondary outcomes included limb ischemia, bleeding, need for renal replacement therapy, multiorgan failure, stroke or transient ischemic attack, and hemolysis.Results
Of 2,221 publications identified, 17 observational studies met the inclusion criteria. In total, outcomes in 3,997 patients were included with 1,696 (42%) receiving a concomitant left ventricular unloading strategy while on VA-ECMO (intra-aortic balloon pump 91.7%, percutaneous ventricular assist device 5.5%, pulmonary vein or transseptal left atrial cannulation 2.8%). There were 2,412 deaths (60%) in the total cohort. Mortality was lower in patients with (54%) versus without (65%) left ventricular unloading while on VA-ECMO (risk ratio: 0.79; 95% confidence interval: 0.72 to 0.87; p < 0.00001). Hemolysis was higher in patients who underwent VA-ECMO with left ventricular unloading. Otherwise, secondary outcomes were not demonstrably different in patients treated with VA-ECMO with versus without left ventricular unloading.Conclusions
In observational studies, left ventricular unloading was associated with decreased mortality in adult patients with cardiogenic shock treated with VA-ECMO. In the absence of prospective randomized data, left ventricular unloading may be considered for appropriately selected patients undergoing VA-ECMO support. 相似文献7.
Jason B. Liu Marshall S. Baker Vanessa M. Thompson E. Molly Kilbane Henry A. Pitt 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):121-131
Background
Whether the choice of antibiotic prophylaxis, the type of incision, or the use of wound protectors decreases surgical site infections (SSIs) in patients undergoing pancreatoduodenectomy (PD) remains unknown.Methods
Patients undergoing open, elective PD between January 1, 2016 and June 30, 2017 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program registry. Multivariable logistic regression models were constructed to determine the association of antibiotic prophylaxis type, incision type, and wound protector use on the incidence of any, superficial, and organ/space SSIs, and to profile hospitals.Results
Overall, 5969 patients were included from 140 hospitals. The overall rate of SSI was 20.3% (n = 1213). Superficial SSIs occurred in 432 (7.2%) patients and organ/space SSIs in 841 (14.1%). Wound protector use was associated with 23% lower odds of experiencing any SSIs (OR 0.77, 95% CI 0.60–0.98), reflective of the decreased odds associated with superficial SSIs (OR 0.65, 95% CI 0.44–0.97), but not organ/space SSIs (OR 0.89, 95% CI 0.68–1.17). Highest-performing hospitals frequently utilized broad-spectrum antibiotics, midline incisions, and wound protectors.Conclusion
Wound protectors reduced superficial, but not organ/space, infections in patients undergoing pancreatoduodenectomy. Routine use of wound protectors in patients undergoing proximal pancreatectomy is recommended. 相似文献8.
Isamu Hosokawa Hiroaki Shimizu Hideyuki Yoshitomi Katsunori Furukawa Tsukasa Takayashiki Satoshi Kuboki Keiji Koda Masaru Miyazaki Masayuki Ohtsuka 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):489-498
Background
Right hepatectomy (RH) is the standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. Therefore, this study aimed to compare the outcomes of LT and RH for PHC.Methods
Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching.Results
Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (37%) underwent LT, and 70 (63%) underwent RH. In a matched cohort (LT: n = 27, RH: n = 27), major complication rates (67% vs. 52%; p = 0.42), 90-day mortality rates (15% vs. 0%; p = 0.11) and R0 resection rates (56% vs. 44%; p = 0.58) were similar in both groups. The 3-year recurrence-free survival rates (27% vs. 47%; p = 0.27) and overall survival rates (45% vs. 60%; p = 0.17) were also similar in both groups.Conclusions
In patients with PHC, LT could achieve similar surgical and survival outcomes as RH. 相似文献9.
Gurumurthy Hiremath Athar M. Qureshi Lourdes R. Prieto Lakshmi Nagaraju Phillip Moore Lisa Bergersen Nathaniel W. Taggart Jeffery Meadows 《JACC: Cardiovascular Interventions》2019,12(3):289-297
Objectives
This study sought to determine whether pulmonary artery intervention in patients with unilateral proximal pulmonary artery stenosis (PAS) improves exercise capacity, abnormal ventilatory response to exercise, and symptoms.Background
Stenosis of the branch pulmonary arteries results in pulmonary blood flow maldistribution (PBFM). The resulting ventilation–perfusion mismatch is associated with an increased ventilatory response to exercise and decreased exercise capacity. It is unclear if technical success in relieving branch PAS translates to clinical improvement in exercise capacity and ventilatory response.Methods
Twenty patients with biventricular circulation and a minimum 10% PBFM who underwent transcatheter relief of PAS were enrolled in a multi-institutional prospective cohort study. Pre- and post-procedure assessment of the degree of PBFM, exercise capacity, ventilatory response to exercise, and subjective assessment of breathlessness were collected and analyzed.Results
Technical success was achieved in all patients with significant angiographic improvement in minimal lumen diameter (p = 0.001) and peak gradient (p = 0.001). Median PBFM improved (19.5% [range 12.0% to 31.0%] before vs. 7.0% [range 0% to 33.0%] after; p = 0.003). Exercise capacity was low at baseline and improved significantly post-intervention; percent predicted peak oxygen consumption improved from 70% (range 45% to 96%) to 83% (range 47% to 121%) (p = 0.02). Percent predicted oxygen pulse improved (p = 0.02). Ventilatory response to exercise improved; ventilatory equivalent of carbon dioxide slope post-intervention decreased to 29.3 versus 32.5 pre-intervention (p = 0.01). Subjective assessment of dyspnea improved. Five patients with minimal improvement in PBFM also showed minimal improvement in exercise parameters.Conclusions
Successful relief of unilateral branch PAS results in significant improvements in exercise capacity, ventilatory efficiency, and symptoms. 相似文献10.
Lauren S. Tufts Emma D. Jarnagin Jessica R. Flynn Mithat Gonen Jose G. Guillem Philip B. Paty Garrett M. Nash Joshua J. Smith Iris H. Wei Emmanouil Pappou Michael I. D&#x;Angelica Peter J. Allen T. Peter Kingham Vinod P. Balachandran Jeffrey A. Drebin Julio Garcia-Aguilar William R. Jarnagin Martin R. Weiser 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):181-186
Background
Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk.Methods
Data were collected on all patients undergoing synchronous colorectal/liver resection from 2011 to 2016 (n = 424). The intervention, implemented in 2013, included 13 multidisciplinary perioperative components. The primary endpoints were superficial/deep and organ space SSIs. Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. To control for changes in SSI rates independent of the intervention, interrupted time series analysis was conducted.Results
Overall, superficial/deep, and organ space SSIs decreased by 60.5% (p < 0.001), 80.6% (p < 0.001), and 47.6% (p = 0.008), respectively. In the pre-intervention cohort (n = 231), there were 79 (34.2%), 31 (13.4%), and 48 (20.8%) total, superficial/deep, and organs space SSIs, respectively. In the post-intervention cohort (n = 193), there were 26 (13.5%), 5 (2.6%), and 21 (10.9%) total, superficial/deep, and organs space SSIs, respectively. Median LOS decreased from 9 to 8 days (p < 0.001). Readmission rates did not change (p = 0.6). Interrupted time series analysis found no significant trends in SSI rate within the pre-intervention (p = 0.35) and post-intervention (p = 0.55) periods.Conclusion
In combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI. 相似文献11.
Daniel J. Blackman Smriti Saraf Philip A. MacCarthy Aung Myat Simon G. Anderson Christopher J. Malkin Michael S. Cunnington Kathryn Somers Paul Brennan Ganesh Manoharan Jessica Parker Omar Aldalati Stephen J. Brecker Cameron Dowling Stephen P. Hoole Stephen Dorman Michael Mullen Simon Kennon David Hildick-Smith 《Journal of the American College of Cardiology》2019,73(5):537-545
Background
Very little is known about long-term valve durability after transcatheter aortic valve replacement (TAVR).Objectives
This study sought to evaluate the incidence of structural valve degeneration (SVD) 5 to 10 years post-procedure.Methods
Demographic, procedural, and in-hospital outcome data on patients who underwent TAVR from 2007 to 2011 were obtained from the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) registry. Patients in whom echocardiographic data were available both at baseline and ≥5 years post-TAVR were included. Hemodynamic SVD was determined according to European task force committee guidelines.Results
A total of 241 patients (79.3 ± 7.5 years of age; 46% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5 to 10 years) were included. A total of 149 patients (64%) were treated with a self-expandable valve and 80 (34.7%) with a balloon-expandable valve. Peak aortic valve gradient at follow-up was lower than post-procedure (17.1 vs. 19.1 mm Hg; p = 0.002). More patients had none/trivial aortic regurgitation (AR) (47.5% vs. 33%), and fewer had mild AR (42.5% vs. 57%) at follow-up (p = 0.02). There was 1 case (0.4%) of severe SVD 5.3 years after implantation (new severe AR). There were 21 cases (8.7%) of moderate SVD (mean 6.1 years post-implantation; range 4.9 to 8.6 years). Twelve of these (57%) were due to new AR and 9 (43%) to restenosis.Conclusions
Long-term transcatheter aortic valve function is excellent. In the authors’ study, 91% of patients remained free of SVD between 5 and 10 years post-implantation. The incidence of severe SVD was <1%. Moderate SVD occurred in 1 in 12 patients. 相似文献12.
Rody El Nawar Bertrand Lapergue Michel Piotin Benjamin Gory Raphael Blanc Arturo Consoli Georges Rodesch Mikael Mazighi Frederic Bourdain Maéva Kyheng Julien Labreuche Fernando Pico 《JACC: Cardiovascular Interventions》2019,12(4):385-391
Objectives
The aim of this study was to determine whether individual operator characteristics have an impact on reperfusion and procedural complication rates.Background
Mechanical thrombectomy (MT) is a Level IA treatment in acute ischemic stroke (AIS) patients. The operator’s effect has been found to be an independent predictor for clinical outcome and technical performance in interventional cardiology.Methods
From the ETIS (Endovascular Treatment in Ischemic Stroke) study, a prospective, multicenter, observational real-world MT registry, the authors included all AIS patients consecutively treated by MT between January 2012 and March 2017 in 3 high-volume comprehensive stroke centers by 19 operators. We assessed the effect of individual operator characteristics on successful reperfusion, defined as modified Thrombolysis In Cerebral Infarction 2b/3 at the end of MT, and procedural complications using multivariable hierarchical logistic regression models.Results
A total of 1,541 patients with anterior and posterior AIS were enrolled (mean age 67 years; median NIHSS 16). There was a significant operator effect on successful reperfusion, with an intraclass correlation coefficient of 0.036 (p = 0.046), but not on complications (intraclass correlation coefficient = 0). There was a dose–response relationship between annual operator volume and successful reperfusion rate (p = 0.003) with an adjusted odds ratio for successful reperfusion equal to 2.52 (95% confidence interval: 1.37 to 4.64) for patients treated by an operator with an annual volume ≥40 MT/year compared with those treated by an operator with <14 MT/year (first tertile). Nevertheless, this result did not translate to better clinical outcomes.Conclusions
Our data suggest that operator volume of MT/year has a positive impact on successful reperfusion in AIS patients, but not on clinical outcomes nor on complication rates. Further studies are warranted to investigate threshold procedure numbers associated with better outcomes. 相似文献13.
Muhammad Ahsan Javed Georg Beyer Nha Le Alessio Vinci Helen Wong Daniel Palmer Robert D. Morgan Angela Lamarca Richard A. Hubner Juan W. Valle Salma Alam Sumsur Chowdhury Yuk Ting Ma Livia Archibugi Gabriele Capurso Patrick Maisonneuve Albrecht Neesse Malin Sund Sebastian Krug 《Pancreatology》2019,19(1):97-104
Background
Pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. Gemcitabine is the standard chemotherapy for patients with metastatic pancreatic adenocarcinoma (MPA). Randomized clinical trials evaluating intensified chemotherapies including FOLFIRINOX and nab-paclitaxel plus gemcitabine (NAB+GEM) have shown improvement in survival. Here, we have evaluated the efficacy of intensified chemotherapy versus gemcitabine monotherapy in real-life settings across Europe.Methods
A retrospective multi-center study including 1056 MPA patients, between 2012 and 2015, from nine centers in UK, Germany, Italy, Hungary and the Swedish registry was performed. Follow-up was at least 12 months. Cox proportional Harzards regression was used for uni- and multivariable evaluation of prognostic factors.Results
Of 1056 MPA patients, 1030 (98.7%) were assessable for survival analysis. Gemcitabine monotherapy was the most commonly used regimen (41.3%), compared to FOLFIRINOX (n = 204, 19.3%), NAB+GEM (n = 81, 7.7%) and other gemcitabine- or 5-FU-based regimens (n = 335, 31.7%). The median overall survival (OS) was: FOLFIRINOX 9.9 months (95%CI 8.4–12.6), NAB+GEM 7.9 months (95%CI 6.2–10.0), other combinations 8.5 months (95%CI 7.7–9.3) and gemcitabine monotherapy 4.9 months (95%CI 4.4–5.6). Compared to gemcitabine monotherapy, any combination of chemotherapeutics improved the survival with no significant difference between the intensified regimens. Multivariable analysis showed an association between treatment center, male gender, inoperability at diagnosis and performance status (ECOG 1–3) with poor prognosis.Conclusion
Gemcitabine monotherapy was predominantly used in 2012–2015. Intensified chemotherapy improved OS in comparison to gemcitabine monotherapy. In real-life settings, the OS rates of different treatment approaches are lower than shown in randomized phase III trials. 相似文献14.
Jawad H. Butt Nikolaj Ihlemann Ole De Backer Lars Søndergaard Eva Havers-Borgersen Gunnar H. Gislason Christian Torp-Pedersen Lars Køber Emil L. Fosbøl 《Journal of the American College of Cardiology》2019,73(13):1646-1655
Background
Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.Objectives
This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.Methods
In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.Results
A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49).Conclusions
The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR. 相似文献15.
Yoav Michowitz Anat Milman Antoine Andorin Georgia Sarquella-Brugada M. Cecilia Gonzalez Corcia Jean-Baptiste Gourraud Giulio Conte Frederic Sacher Jimmy J.M. Juang Sung-Hwan Kim Eran Leshem Philippe Mabo Pieter G. Postema Aviram Hochstadt Yanushi D. Wijeyeratne Isabelle Denjoy Carla Giustetto Yuka Mizusawa Bernard Belhassen 《Journal of the American College of Cardiology》2019,73(14):1756-1765
Background
Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited.Objectives
The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence.Methods
A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31).Results
Patients’ median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents.Conclusions
Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered. 相似文献16.
Didier Tchétché Stephan Windecker A. Markus Kasel Ulrich Schaefer Stephen Worthley Axel Linke Mohamed Abdel-Wahab Herve Le Breton Lars Søndergaard Mark S. Spence Sonia Petronio Helmut Baumgartner Tomas Hovorka Philipp Blanke Hermann Reichenspurner 《JACC: Cardiovascular Interventions》2019,12(7):673-680
Objectives
The purpose of this study is to report the 1-year results of the CENTERA-EU trial.Background
The CENTERA transcatheter heart valve (THV) (Edwards Lifesciences, Irvine, California) is a low-profile (14-F eSheath compatible), self-expanding nitinol valve, with a motorized delivery system allowing for repositionability. The 30-day results of the CENTERA-EU trial demonstrated the short-term safety and effectiveness of the valve.Methods
Implantations were completed in 23 centers in Europe, Australia, and New Zealand. Transfemoral access was used in all patients. Echocardiographic outcomes were adjudicated by a core laboratory at baseline, discharge, 30 days, 6 months, and 1 year. Major adverse clinical events were adjudicated by an independent clinical events committee.Results
Between March 2015 and July 2016, 203 high-risk patients (age 82.7 ± 5.5 years, 67.5% women, 68.0% New York Heart Association functional class III or IV, Society of Thoracic Surgeons score 6.1 ± 4.2%) with severe, symptomatic aortic stenosis underwent transcatheter aortic valve replacement with the CENTERA THV. The primary endpoint of the study was 30-day mortality (1.0%). At 1 year, overall mortality was 9.1%, cardiovascular mortality was 4.6%, disabling stroke was 4.1%, new permanent pacemakers were implanted in 6.5% of patients at risk, and cardiac-related rehospitalization was 6.8%. Hemodynamic parameters were stable at 1 year, with a mean aortic valve gradient of 8.1 ± 4.7 mm Hg, a mean effective orifice area of 1.7 ± 0.42 cm2, and no incidences of severe or moderate aortic regurgitation.Conclusions
The CENTERA-EU trial demonstrated mid-term safety and effectiveness of the CENTERA THV, with low mortality, sustained improvements in hemodynamic performances, and low incidence of permanent pacemaker implantations in high-risk patients with symptomatic aortic stenosis. (Safety and Performance of the Edwards CENTERA-EU Self-Expanding Transcatheter Heart Valve [CENTERA-2]; NCT02458560) 相似文献17.
Fernando Domínguez Valentín Fuster Juan Miguel Fernández-Alvira Leticia Fernández-Friera Beatriz López-Melgar Ruth Blanco-Rojo Antonio Fernández-Ortiz Pablo García-Pavía Javier Sanz José M. Mendiguren Borja Ibañez Héctor Bueno Enrique Lara-Pezzi José M. Ordovás 《Journal of the American College of Cardiology》2019,73(2):134-144
Background
Sleep duration and quality have been associated with increased cardiovascular risk. However, large studies linking objectively measured sleep and subclinical atherosclerosis assessed in multiple vascular sites are lacking.Objectives
The purpose of this study was to evaluate the association of actigraphy-measured sleep parameters with subclinical atherosclerosis in an asymptomatic middle-aged population, and investigate interactions among sleep, conventional risk factors, psychosocial factors, dietary habits, and inflammation.Methods
Seven-day actigraphic recording was performed in 3,974 participants (age 45.8 ± 4.3 years; 62.6% men) from the PESA (Progression of Early Subclinical Atherosclerosis) study. Four groups were defined: very short sleep duration <6 h, short sleep duration 6 to 7 h, reference sleep duration 7 to 8 h, and long sleep duration >8 h. Sleep fragmentation index was defined as the sum of the movement index and fragmentation index. Carotid and femoral 3-dimensional vascular ultrasound and cardiac computed tomography were performed to quantify noncoronary atherosclerosis and coronary calcification.Results
When adjusted for conventional risk factors, very short sleep duration was independently associated with a higher atherosclerotic burden with 3-dimensional vascular ultrasound compared to the reference group (odds ratio: 1.27; 95% confidence interval: 1.06 to 1.52; p = 0.008). Participants within the highest quintile of sleep fragmentation presented a higher prevalence of multiple affected noncoronary territories (odds ratio: 1.34; 95% confidence interval: 1.09 to 1.64; p = 0.006). No differences were observed regarding coronary artery calcification score in the different sleep groups.Conclusions
Lower sleeping times and fragmented sleep are independently associated with an increased risk of subclinical multiterritory atherosclerosis. These results highlight the importance of healthy sleep habits for the prevention of cardiovascular disease. 相似文献18.
Haotian Gu Sahrai Saeed Andrii Boguslavskyi Gerald Carr-White John B. Chambers Phil Chowienczyk 《JACC: Cardiovascular Imaging》2019,12(1):52-63
Objectives
This study investigated the prognostic value of first-phase ejection fraction (EF1) in patients with aortic stenosis (AS), a condition in which left ventricular dysfunction as measured by conventional indices is an indication for valve replacement.Background
EF1, the ejection fraction up to the time of maximal ventricular contraction may be more sensitive than existing markers in detecting early systolic dysfunction.Methods
The predictive value of EF1 compared to that of conventional echocardiographic indices for outcomes was assessed in 218 asymptomatic patients with at least moderate AS, including 73 with moderate, 50 with severe, and 96 with “discordant” (aortic area <1.0 cm2 and gradient <40 mm Hg) AS, all with preserved EF, followed for at least 2 years. EF1 was measured retrospectively from archived echocardiographic images by wall tracking of the endocardium. The primary outcome was a combination of aortic valve intervention, hospitalization for heart failure, and death from any cause.Results
EF1 was the most powerful predictor of events in the total population and all subgroups. A cutoff value of 25% (or EF1 of <25% compared to ≥25%) gave hazard ratios of 27.7 (95% confidence interval [CI]: 13.1 to 58.7; p < 0.001) unadjusted and 24.4 (95% CI: 11.3 to 52.7; p < 0.001) adjusted for other echocardiographic measurements including global longitudinal strain, for events at 2 years in all patients with asymptomatic AS. Corresponding hazard ratios for all-cause mortality in the total population were 17.5 (95% CI: 5.7 to 53.3) and 17.4 (95% CI: 5.5 to 55.2) unadjusted and adjusted, respectively.Conclusions
EF1 may be potentially valuable in the clinical management of patients with AS and other conditions in which there is progression from early to late systolic dysfunction. 相似文献19.
Hiroki Ikenaga Jun Yoshida Atsushi Hayashi Takafumi Nagaura Satoshi Yamaguchi Florian Rader Robert J. Siegel Saibal Kar Takahiro Shiota 《JACC: Cardiovascular Interventions》2019,12(2):140-150
Objectives
The aim of this study was to determine the prognostic value of pulmonary venous (PV) flow during MitraClip implantation.Background
The clinical significance of PV flow information during MitraClip implantation is unknown.Methods
A total of 300 patients who underwent MitraClip implantation and in whom the measurement of PV flow was completed using intraprocedural transesophageal echocardiography were retrospectively reviewed. The optimal threshold of the ratio of systolic velocity-time integral (Svti) to diastolic velocity-time integral (Dvti) ratio after MitraClip placement for major adverse cardiovascular events (all-cause death, redo MitraClip implantation, mitral valve surgery, and heart transplantation) during 12 months was assessed. The best cutoff ratio was 0.72. Patients were divided into 2 groups using this cutoff ratio (low Svti/Dvti, n = 91; high Svti/Dvti, n = 209).Results
Following mitral regurgitation reduction by MitraClip placement, Svti increased in the both groups. The frequency of mitral regurgitation 3/4+ immediately after MitraClip implantation, at 1-month follow-up, and at 12-month follow-up was significantly higher in patients with low Svti/Dvti ratios than in those with high Svti/Dvti ratios (after MitraClip placement, 5.5% vs. 0%; p < 0.001; at 1 month; 26% vs. 5.2%; p < 0.001; at 12 months, 18% vs. 5.3%; p = 0.006). Major adverse cardiovascular events during 12 months were significantly higher in patients with low Svti/Dvti ratios than in those with high Svti/Dvti ratios (23% vs. 6.2%; p < 0.001). Multivariate analysis demonstrated that low Svti/Dvti ratio was significantly associated with major adverse cardiovascular events during 12 months after adjustment for age, baseline renal function, and mean transmitral pressure gradient (adjusted hazard ratio: 4.00; 95% confidence interval: 2.02 to 8.23; p < 0.001).Conclusions
PV flow information in the catheterization laboratory immediately after MitraClip implantation predicted recurrent mitral regurgitation and worse long-term outcomes. 相似文献20.
Jenny Rystedt Bobby Tingstedt Christoph Ansorge Johan Nilsson Bodil Andersson 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):268-274