bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of surgical bailout after transcatheter aortic valve replacement in Germany
Authors: Oettinger V , Heidenreich A , Kaier K , Zehender M , Bode C , Duerschmied D , Stachon P , Von Zur Muehlen C 
Published: October 2022

Abstract

Background
Severe complications during transcatheter aortic valve replacement (TAVR) may require a surgical bailout. However, little is known about the outcomes after bailout in Germany.

Methods
All TAVR between 2007 and 2020 were identified using German national electronic health records, with focus on 2018 to 2020. Additionally, those procedures requiring surgical bailout were selected.

Results
A total of 159,643 patients received TAVR. Overall rate of surgical bailout was 2.30% and overall in-hospital mortality 3.85%. In-hospital mortality after surgical bailout was 16.51%. While the annual number of procedures in all TAVR rose steeply (202 to 22,972), the rate of surgical bailout dropped from 27.23 to 0.61% and that of overall mortality from 11.39 to 2.29%. However, mortality in case of surgical bailout remained high with 28.37% in 2020. After risk adjustment, in 2018 to 2020, standardized rates of overall in-hospital mortality and surgical bailout for both balloon-expandable and self-expanding transfemoral TAVR were significantly lower than for transapical TAVR (transapical vs transfemoral balloon-expandable vs self-expanding TAVR: in-hospital mortality: 5.66% [95% CI 4.81%; 6.52%] vs 2.30% [2.03%; 2.57%] vs 2.32% [2.07%; 2.57%]; surgical bailout: 2.33% [1.68%; 2.97%] vs 0.79% [0.60%; 0.98%] vs 0.42% [0.31%; 0.53%]). Main risk factors for surgical bailout were coronary artery disease (risk adjusted OR=1.50 [1.21; 1.85], p&lt;0.001), atrial fibrillation (OR=1.29 [1.07; 1.57], p=0.009), and higher grade heart failure NYHA III/IV (OR=1.26 [1.01; 1.57], p=0.037).

Conclusion
Rates of surgical bailout as well as overall in-hospital mortality after TAVR decrease substantially over the years. However, in the case of surgical bailout, outcomes remain poor with a constantly high in-hospital mortality.

Funding Acknowledgement
Type of funding sources: None.
Readmission after transcatheter aortic valve implantation according to frailty
Authors: Strange J E , Christensen D M , Sindet-Pedersen C , Gislason G , Schou M , Oestergaard L , Butt J H , Graversen P L , Koeber L , Olesen J B , Fosboel E L 
Published: October 2022

Abstract

Background
Readmissions and time spent hospitalized following transcatheter aortic valve implantation (TAVI) are important parameters of patient autonomy, particularly for frail patients with limited life-expectancy. Yet, such data remain scarce.

Purpose
To investigate actual time spent hospitalized the first year after TAVI. Secondly, to investigate time spent hospitalized according to frailty risk.

Methods
Through Danish, nationwide registries, we included all patients undergoing TAVI and alive at discharge between January 2008 and June 2020. From discharge, patients were followed until death, emigration, end of study period, or one year of follow-up, whichever came first. During follow-up, all in-patient hospital admissions were identified according to ICD-10 diagnosis codes. Length of stay was calculated, and cumulative numbers of days hospitalized was presented. Further, the proportion of patients dying within one year of follow-up was calculated.
Using The Hospital Frailty Risk Score, a validated frailty risk assessment tool, patients were categorized as low, intermediate, and high frailty risk. We then evaluated the time spent hospitalized stratified by frailty risk group.

Results
The study population comprised 5,464 patients undergoing first-time TAVI with a median age of 81 years among whom 55.2% were males. After one year, 445 (8.1%) patients had died. In total, 2,452 (44.9%) of TAVI patients survived one year and were never admitted, whereas 3,012 (55.1%) patients were admitted at least once or died within one year of TAVI. Of these, 1,200 (21.9%) patients were admitted for more than two weeks or died within one year of TAVI (Figure 1).
Regarding frailty, 3,296 (60.3%), 1,965 (36.0%), and 203 (3.7%) patients were classified as low, intermediate, and high frailty risk, respectively. In the low frailty risk group, 6.2% of patients died within one year and 50.4% survived one year without a hospital admission. By contrast, 16.7% of patients in the high frailty risk group died within one year and only 24.6% survived one year without a hospital admission. Further, 17.1% of patients in the low frailty risk group were admitted for more than two weeks or died within one year of TAVI compared with 47.3% in the high frailty risk group (Figure 2).

Conclusion
Readmissions in the first year after transcatheter aortic valve implantation were common and time spent hospitalized after transcatheter aortic valve implantation was significant. Our results were clearly related to frailty, which should be considered for future prevention strategies.

Funding Acknowledgement
Type of funding sources: None.
Intravascular lithotripsy to facilitate transfemoral TAVI: a single-center experience
Authors: Steblovnik K , Cercek M , Sustersic M , Terseglav S , Bunc M 
Published: October 2022

Abstract

Introduction
Transfemoral is considered the approach of choice for transcatheter aortic valve implantation (TAVI) and improves clinical outcomes such as death or stroke compared to transaortic or transapical access. Intravascular lithotripsy (IVL) has enabled modification of calcified intimal and medial lesions to increase vascular wall compliance which might facilitate the transfemoral TAVI approach.

Purpose
To present a single-center experience with intravascular lithotripsy facilitating transfemoral TAVI approach.

Methods
A peripheral IVL catheter was used to perform lithotripsy of calcified iliofemoral stenosis. A 0.014" guidewire was used to guide the lithotripsy catheter with a balloon diameter of 5.0 or 6.0 mm. Inflating the balloon with 4–6 atm of pressure enabled apposition with the arterial wall and several cycles of 30 pulses have been performed at various locations of the iliofemoral arteries. IVL was planned in advance as primary strategy in case of ring or as baillout strategy in case of ring or excentric calcified periferial artery stenosis, respectively. The IVL was immediately followed by transfemoral TAVI. Retrograde data were collected for the purpose of this abstract.

Results
From December 2019 to December 2021 433 TAVI procedures were performed in the University Medical Centre Ljubljana. In 13 of the procedures (3%) IVL was used to facilitate the transfemoral approach. The mean minimal diameter of iliofemoral arteries was 5,2 mm with calcifications affecting at least three-quarters of arterial circumference in 92% and circular calcifications in 62% of cases. In all cases, IVL was performed in a common iliac artery or aortic bifurcation, while external iliac (15%) or femoral (8%) arteries were treated less often. A 5 mm IVL balloon was used in 2 (15%), and a 6 mm balloon in 9 (69%) cases, while a combination of 5 and 6 mm balloons was used in 2 (15%) cases. IVL and subsequent TAVI were successful in all the cases. No hospital mortality or major bleeding was observed. One patient needed one unit of blood transfusion due to loss during planned surgical preparation and closure of the puncture site. The puncture site was closed using a 2 Proglide technique and no conversion from percutaneous to surgical puncture site closure was needed. A self-expanding aortic prosthesis (Evolut R, Medtronic) was used in 11 (85%) and a balloon-expandable (Sapien 3, Edwards Lifesciences) in 2 (15%) cases.

Conclusion
In our experience IVL of iliofemoral arteries is a safe and effective method to facilitate transfemoral approach in TAVI, especially in cases of circular calcifications affecting the majority of arterial wall circumference.

Funding Acknowledgement
Type of funding sources: None.
Application of machine learning to identify top determinants of fibrofatty plaque burden by CCTA in humans with psoriasis
Authors: Hong C , Li H , Parel P M , Berg A R , Rodante J , Keel A , Teague H L , Playford M P , Chen M Y , Zhou W , Sorokin A V , Bluemke D A , Mehta N N 
Published: October 2022

Abstract

Introduction
Fibrofatty plaque burden (FFB) is a high-risk, vulnerable plaque feature comprised of an atheromatous core and fibrous cap with increased risk of coronary artery disease (CAD) [1]. Psoriasis (PSO) is a chronic inflammatory disease linked with atherosclerotic risk and premature cardiovascular disease, driven in part by vulnerable plaque rupture [2,3]. Machine learning (ML) previously showed the prognostic value of FFB in predicting 5-year risk of cardiac-related mortality in patients with CAD [4]. Whether ML can predict FFB in psoriasis is understudied.

Purpose
To use ML to identify top determinants of FFB by CCTA in PSO.

Methods
320 consecutive participants with psoriasis were recruited as part of an ongoing cohort study, of whom 307 had FFB analyzed with coronary computed tomography angiography (CCTA) and quantified by QAngio CT (Medis, The Netherlands). 140 out of 182 potential determinants were subjected to ML algorithms analyzed by random forest and validated by 5-fold cross validation to select the top determinants based on R-square criteria. Lipid concentration and size were measured by nuclear magnetic resonance (NMR) and sdLDL-C was calculated by Sampson's formula.

Results
The top 21 determinants of FFB at baseline were grouped into 3 categories: cardiometabolic risk factors (BMI, sex, DBP, mean arterial pressure, exercise, heart rate, glucose, anxiety, psoriasis disease duration), clinical measurements (basophils, platelets, hemoglobin, RBC, alkaline phosphatase, ALT, creatinine, neutrophil-to-lymphocyte ratio), and lipoproteins (LDL particle size, apolipoprotein A1, apolipoprotein B-to-A1 ratio, calculated sdLDL-C).

Conclusion
ML confirmed that FFB strongly correlates with cardiometabolic risk factors, clinical measurements, and lipoproteins. Further investigations into these top determinants of FFB over time may provide insight into potential therapeutic interventions that decrease cardiovascular risk in patients with chronic inflammatory diseases and should be validated in larger studies.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by the National Heart, Lung and Blood Institute (NHLBI) IntramuralResearch Program (ZIA-HL-06193). This research was made possible through the NIH MedicalResearch Scholars Program, a public-private partnership supported jointly by the NIH andcontributions to the Foundation for the NIH from the Doris Duke Charitable Foundation,Genentech, the American Association for Dental Research, the Colgate-Palmolive Company, andother private donors.
Outcomes following patent foramen ovale percutaneous closure according to the delay from last ischemic event
Authors: Guedeney P , Mesnier J , Michel M , Hauguel-Moreau M , Silvain J , Houde C , Alperi A , Panagides V , Collet J P , Wallet T , Rouanet S , Hammoudi N , Rodes-Cabau J , Montalescot G 
Published: October 2022

Abstract

Background
Randomized controlled trials evaluating patent foramen ovale (PFO) percutaneous closure only included patients with recent embolic event. We aimed to evaluate outcomes following percutaneous PFO closure outcomes according to the delay from the last embolic episode.

Methods
This international ambispective cohort included consecutive patients from two centers in France and Canada undergoing PFO percutaneous closure for secondary prevention of paradoxical embolic event. The primary endpoint was the composite of stroke or transient ischemic attack (TIA). Logistic regression model was used to evaluate determinants of late PFO closure procedures.

Results
A total of 1,179 patients (mean age 49±12.7 years; 44.4% female) underwent PFO closure from 2001 to 2021 (Figure 1). The median delay from last embolic event to procedure was 6.0 (3.4–11.2) months. Determinants of late PFO closure procedure were the center (France versus Canada) adjusted Odds Ratio (aOR) 1.65 95% confidence interval (CI) 1.25–2.19, year of procedure (≥2018 versus &lt;2018) aOR 1.43 95% CI 1.08–1.90, female sex aOR 1.63 95% CI 1.28–2.07 and lower RoPE score aOR 1.10 95% CI 1.03–1.19. After a median follow-up of 2.61 (1.13–7.25) years, the incidence rate of first stroke or TIA did not differ between early and late PFO procedures with 0.51 versus 0.29 events per 100 patient-years, respectively, incidence rate ratio 1.74 95% CI 0.66–5.08, p=0.25 (Figure 2). In univariate analysis, late PFO percutaneous closure was not associated with the occurrence of stroke or TIA, with hazard ratio 0.54 95% CI 0.22–1.34 p=0.17.

Conclusion
This analysis provides indirect evidence that delay from last ischemic event does not impact outcomes following PFO percutaneous closure for secondary prevention.

Funding Acknowledgement
Type of funding sources: None.
Clinical impact of peri-device leaks following percutaneous left atrial appendage occlusion: a systematic review and meta-analysis
Authors: Samaras A , Papazoglou A , Balomenakis C , Bekiaridou A , Moysidis D , Patsiou V , Orfanidis A , Feidakis A , Giannakoulas G , Tzikas A 
Published: October 2022

Abstract

Background
Peri-device leaks (PDL) are quite common after left-atrial appendage occlusion (LAAO) given the complex anatomy of LAA and surrounding structures. However, there is uncertainty regarding the prognostic implications of PDL.

Material and methods
Literature search was conducted in MEDLINE (PubMed), EMBASE, Scopus by ELSEVIER and Cochrane Central Register of Controlled Trials (CENTRAL) databases until 12 October 2021. A random-effects meta-analysis was performed to assess the effect of PDL presence on thromboembolism, all-cause mortality and major bleeding occurrence. Sensitivity analyses accounted for: i. the combined AF ablation performance, ii. the anticoagulation strategy followed after LAAO, iii. mean PDL size, and iv. mean female percentage.

Results
Of 699 articles initially retrieved, 46 were deemed eligible for this analysis (9,184 AF patients undergoing LAAO out of whom 1,446 had PDL). PDL presence was significantly associated with elevated odds of thromboembolism (FIgure 1) [pooled odds ratio (pOR) 3.05, 95% confidence interval (CI) 1.94–4.81; I2=37%]; yet PDL was not significantly linked with mortality (pOR=0.86, 95% CI: 0.25–2.95; I2=69%) and major bleeding rates (0.95, 95% CI: 0.27–3.35; I2=72%). AF-ablation did not significantly interact with the prognostic impact of PDL when performed in conjunction with LAAO (p for subgroup= 0.17). Antiplatelet discharge medication affected the prognostic value of PDL (p for subgroup &lt;0.01 and =0.04, respectively). The prognostic significance of mean PDL size [peri-procedural or at 1–3 months or D(mean size)/D(time of follow-up)] on the risk of thromboembolism did not yield any significant association (p values &gt;0.05). Meta-regression analysis of the mean female percentage demonstrated a non-significant trend towards a positive linear correlation between female percentage and risk of thromboembolism (p=0.10) (FIgure 2).

Conclusions
This is the first meta-analysis on the prognostic impact of PDL after LAAO. The findings highlighted a significant association between PDL and thromboembolic events, warranting careful post-LAAO device surveillance.

Funding Acknowledgement
Type of funding sources: None.
Total arterial revascularization is associated with long-term survival benefit in coronary artery bypass grafting: systematic review with meta-analysis
Authors: Ren J , Royse A , Tian D , Royse C , Boggett S , Bellomo R , Gaudino M , Fremes S 
Published: October 2022

Abstract

Importance
Total arterial revascularization (TAR), the complete avoidance of saphenous vein grafting (SVG) in coronary artery bypass grafting (CABG), is advocated based on the superior conduit durability and resistance against atherosclerosis. However, the low adoption rate of TAR indicates a high level of controversy.

Objective
To compare long-term survival between TAR and conventional CABG involving SVG.

Data sources
A comprehensive literature search was conducted through digital databases including MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from the inception to May 2021.

Study selection
The inclusion criteria were randomized clinical trials, or propensity-score balanced or multivariable-adjusted observational studies with a sample size of at least 100 patients in each arm, isolated CABG, comparing TAR (SVG=0) vs. non-TAR (SVG≥1), and inclusion of all-cause mortality.

Data extraction and synthesis
Two reviewers performed independent extraction following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were estimated with random-effect and fixed-effect models using generic inverse variance weighting. Individual patient time-to-event data were reconstructed to create an overall Kaplan-Meier survival function for matched studies. Sensitivity analyses were performed according to the risk of bias, matching status, and source of HR.

Main outcomes and measures
The primary endpoint was all-cause mortality.

Results
A total of 23 studies (100,314 patients), all with a retrospective observational design, were identified. The weighted mean follow-up time was 8.8 years post-operatively. Total arterial revascularization was associated with greater freedom from all-cause mortality than non-TAR (HR, 0.77, 95% CI, 0.71 to 0.84, p&lt;0.001). There was evidence of low heterogeneity (I2=45%) across studies. Low publication bias was observed. Leave-one-out influence analysis and sensitivity analyses produced consistent results. Cochrane Collaboration signaling domains showed no critical risk of bias.

Conclusions and relevance
This meta-analysis found superior late survival associated with total arterial revascularization. Further randomized clinical trials are needed.

Funding Acknowledgement
Type of funding sources: None.
Impact of surgical left atrial appendage closure during coronary bypass on clinical outcomes and readmissions
Authors: Wu L , Narasimhan B , Yang Z R , Shah A N , Kantharia B K 
Published: October 2022

Abstract

Background
Whether surgical left atrial appendage closure (sLAAC) during coronary artery bypass (CABG)surgery improves post-operative outcome including stroke and atrial fibrillation (AF) occurrence is largely unknown.

Objective
To analyze the impact of concomitant sLAAC during CABG in terms of outcomes and readmissions over the following year.

Methods
We analyzed the Nationwide Readmissions Database (2016–2019) using ICD-10 codes to identify hospitalizations for CABG. Patients were subcategorized based on whether sLAAC was performed or not. Among patients who survived their index admission, we employed propensity matching (1:3) to adjust for age, sex, comorbidities, CHA2DS2-VASc scores, previous AF history, heart failure and hospital characteristics. Primary outcomes included unplanned AF and stroke-related readmissions at 1 year.

Results
A total of 58,311 patients with CABG and sLAAC were identified with 175,940 propensity matched controls. Patients undergoing sLAAC were older with higher CHA2DS2-VASc scores and comorbidity burdens. Confounders were well balanced following propensity matching. Over a mean follow-up of 152 days, sLAAC was associated with higher risk of readmission due to AF at one year (HR 1.71 [1.49–1.96] p&lt;0.001). This association is independent of previous AF history. Lower rates of stroke-related readmission was associated with perfomance of sLAAC (HR 0.80 (0.65–0.97) p=0.026), however the association was not observed when accounting for AF history.

Conclusion
CABG with concomitant sLAAC is maybe associated with lower stroke risk at the cost of higher risk of AF readmissions.

Funding Acknowledgement
Type of funding sources: None.
Large multinational evaluation of time to reintervention in patients undergoing bioprosthetic valve implantation during open heart surgery
Authors: Maller T , Perel N , Simonato M , Harari E , Tager S , Fink D , Jacobson E , Glikson M , Dvir D 
Published: October 2022

Abstract

Introduction
Bioprosthetic valves are increasingly utilized during open heart surgery in favor of mechanical valves. These tissue valves are prone for structural valve degeneration and failure, especially in young patients. Transcatheter aortic valve implantation (TAVI) is an appealing approach in these patients.

Purpose
To describe independent correlates for early need for reintervention.

Method
We used a large multicenter registry of patients (&gt;45 years of age) with failed bioprosthetic surgical valves undergoing TAVI valve-in-valve (VinV) in either aortic or the mitral positions. Early reintervention was (&lt;5 years between open-heart surgery and VinV). Multi-variable properties that were included: patient gender, age at open-heart surgery, valve size, baseline renal failure, position of valve implantation, and bioprosthetic valve label size.

Results
A total of 3,324 patients were included in the study (age at the time of open heart surgery 68.9+7.9 years). Median time to TAVI was 9 years (IQR 6–13 years). A total of 632 (19%) patients experienced early valve degeneration with median time to TAVI of only 3 years [IQR 1–5]. Patients with early degeneration were older than those without early degeneration (mean age at surgery was 72.8±9 years vs. 68.9±8 years; p&lt;0.001). in addition, significant linear relation between older patient age and early valve degeneration (p for trend &lt;0.001). Re-intervention in the mitral position was more common in the group of patients with early degeneration (24.4% vs 18.2% without early degeneration; p&lt;0.001) Patient age and mitral valve position were independently associated with increased rate of early degeneration (OR 1.09 [1.08–1.11], p&lt;0.001; OR 1.62 [1.31–2.01]; p&lt;0.001 respectively).

Conclusions
In this large multicenter analysis of patients undergoing TAVR for failed bioprosthetic valves we identified old patient age and mitral valve (vs. aortic) as independent correlates for early intervention. A discrepancy with known association of young age and rapid bioprosthetic valve degeneration is to be determined.

Funding Acknowledgement
Type of funding sources: None.