The Changing Face of Cardiac Surgery: Practice Patterns and Outcomes 2001-2010

Buth, Karen J.; Gainer, Ryan; Légaré, Jean‐François; Hirsch, Gregory M.

doi:10.1016/j.cjca.2013.10.020

Cited by 50 publications

(53 citation statements)

References 21 publications

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“…13 In the present study, the overall incidence rates of valvular surgery in Nova Scotia remained unchanged between 2010 and 2014, whereas the rates increased in New Brunswick and Newfoundland and Labrador, although still remaining below those of Nova Scotia. It should be noted that, for the purposes of this study, we analyzed data for all patients who received care at a particular centre as originating from that region and did not specifically try to identify out-ofregion patients.…”

Section: Discussionmentioning

confidence: 40%

“…The practice pattern seen in Nova Scotia was well established before the adoption of TAVI, in 2012, with previously published rates of bioprosthesis use greater than 80%. 13 In addition, there has been a general change worldwide in practice favouring bioprostheses, with which repeat surgery may be less of a concern when TAVI is an option. 14,15 In fact, the differences we observed represent important practice variations that are unique to the philosophy and interpretation of the evidence by the clinician group practising at each institution.…”

Section: Discussionmentioning

confidence: 99%

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Regional differences in aortic valve replacements: Atlantic Canadian experience

McGuire

Yip

MacLeod

et al. 2018

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Background: Transcatheter aortic valve implantation (TAVI) is evolving rapidly and is increasingly being adopted in the treatment of aortic valve disease. The goal of this study was to examine regional differences in surgical aortic valve replacement (SAVR) and TAVI across Atlantic Canada. Methods:We identified all patients who underwent SAVR or TAVI between Jan. 1, 2010, and Dec. 31, 2014, in New Brunswick, Nova Scotia and Newfoundland and Labrador. Data obtained included patient demographic characteristics and surgical procedure details. We performed univariate descriptive analyses and calculated crude and age-and sex-adjusted incidence rates.Results: A total of 3042 patients underwent SAVR or TAVI during the study period, 1491 in Nova Scotia, 1042 in New Brunswick and 509 in Newfoundland and Labrador. Patient demographic characteristics were similar across regions. A much higher proportion of patients in Newfoundland and Labrador (43.6%) than in Nova Scotia (4.2%) or New Brunswick (13.6%) received a mechanical versus a bioprosthetic valve. Rates of TAVI increased over the study period, with New Brunswick adopting their program before Nova Scotia (144 v. 74 procedures). Adjusted rates of all AVR procedures remained stable in Nova Scotia (40-50 per 100 000 people). Adjusted rates were lower in New Brunswick and Newfoundland and Labrador than in Nova Scotia; they increased slowly in New Brunswick over the study period. Conclusion:Despite geographical proximity and similar patient demographic characteristics, there existed regional differences in the management of aortic valve disease within Atlantic Canada. Further study is required to determine whether the observed differences in age-and sex-adjusted rates of AVR may be explained by geographical disease-related differences, varying practice patterns or barriers in access to care. Contexte :Le remplacement valvulaire aortique par cathéter, une méthode en pleine évo-lution, est de plus en plus utilisé pour le traitement des valvulopathies aortiques. Cette étude visait à examiner les différences régionales quant au remplacement valvulaire aortique par cathéter ou par chirurgie dans les provinces de l'Atlantique. Résultats : En tout, 3042 patients ont subi un remplacement valvulaire aortique par cathéter ou par chirurgie pendant la période à l'étude : 1491 en Nouvelle-Écosse, 1042 au Nouveau-Brunswick et 509 à Terre-Neuve-et-Labrador. Les caractéristiques démogra-phiques des patients étaient semblables d'une région à l'autre. La proportion des patients recevant une prothèse mécanique plutôt qu'une bioprothèse était beaucoup plus élevée à Terre-Neuve-et-Labrador (43,6 %) qu'en Nouvelle-Écosse (4,2 %) ou au NouveauBrunswick (13,6 %). Les taux de remplacement par cathéter ont augmenté au cours de la période à l'étude; le Nouveau-Brunswick a adopté un programme à ce sujet avant la Nouvelle-Écosse (144 c. 74 interventions). Les taux corrigés pour tous les remplacements étaient stables en Nouvelle-Écosse (40-50 par 100 000 habitants); ils étaient plus faibles au Nouveau...

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Section: Discussionmentioning

confidence: 40%

Section: Discussionmentioning

confidence: 99%

Regional differences in aortic valve replacements: Atlantic Canadian experience

McGuire

Yip

MacLeod

et al. 2018

cjs

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“…They have increased mortality and are at increased risk for prolonged ICU stay and adverse events, such as stroke, infections and acute kidney injury (AKI). 15 In their study, about 60% were isolated CABG cases, reviewed 2001-2010, and the mortality for patients defined as frail was 14%. Patients included in their study had an average EuroScore of 6%.…”

Section: Discussionmentioning

confidence: 99%

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly

et al. 2015

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Advanced age is a known risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial assesses the impact of MECC on the outcome of elderly patients undergoing CABG. Eight hundred and seventy-five patients (mean age 78.35 years) underwent isolated CABG using CECC (n=345) or MECC (n=530). The MECC group had a significantly shorter extracorporeal circulation time (ECCT), cross-clamp time and reperfusion time and lower transfusion needs. Postoperatively, these patients required significantly less inotropic support, fewer blood transfusions, less postoperative hemodialysis and developed less delirium compared to CECC patients. In the MECC group, intensive care unit (ICU) stay was significantly shorter and 30-day mortality was significantly reduced [2.6% versus 7.8%; p<0.001]. In conclusion, MECC improves outcome in elderly patients undergoing CABG surgery.

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“…Nowadays, in the setting of cardiac surgery, elderly patients are more likely to have extensive coronary artery disease and concomitant valvular disease, requiring combined cardiac intervention and need urgent or emergent surgery [2]; nevertheless, new surgery and anesthesiological techniques have resulted in sizeable benefits also for the elderly. However, the clinical and functional complexities of older patient candidate to cardiac surgery have highlighted the significant limitations regarding postoperative predictive power of current cardiac surgery risk scores such as EUROSCORE logistic I and II and STS score [3].…”

Section: The Current Evidences Of Cardiac Surgery In the Elderlymentioning

confidence: 99%

“…Independently from different methods of measure, the presence of frailty is often recognized in older patients candidate to urgent or elective cardiac surgery; data from Canadian registry of cardiac surgery demonstrated that the rate of patients defined as frail increase from 5% to 10% in a period from 2005 to 2010 and in patients over 80 years old the rate raised over 20% [2]. Original Article pime pime pime pime p pi im me e EDITRICE The patient centered outcomes: the role of functional capacity, quality of life and disability free-survival…”

Section: The Role Of Preoperative Frailtymentioning

confidence: 99%

Cardiac surgery in the elderly: What goals of care?

Pratesi

Orso

Ghiara

et al. 2017

Monaldi Arch Chest Dis

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At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity; however significant difficulties must be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients' centered outcome such as disability free survival. In this perspective, more than one geriatric statement have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients' centered outcomes are considered as primary goals of therapies as well as cardiovascular ones. The current evidences of cardiac surgery in the elderlyAt this time, more than half of cardiac surgery interventions is being performed in patients older than 75 years and this group of patients is steadily rising over time [1].This epidemiological phenomenon has compelled cardiac surgeons to face with a different and more complex clinical scenario represented by patients often accompanied by a larger burden of non-cardiac comorbid conditions and greater illness severity [1]. Nowadays, in the setting of cardiac surgery, elderly patients are more likely to have extensive coronary artery disease and concomitant valvular disease, requiring combined cardiac intervention and need urgent or emergent surgery [2]; nevertheless, new surgery and anesthesiological techniques have resulted in sizeable benefits also for the elderly. However, the clinical and functional complexities of older patient candidate to cardiac surgery have highlighted the significant limitations regarding postoperative predictive power of current cardiac surgery risk scores such as EUROSCORE logistic I and II and STS score [3].Recently authors showed that the predictive value of many currently available risk-scoring algorithms (ACEF, EUROSCORE I and II, STS score) was insufficient to allow a precise and reliable risk assessment in patients undergoing surgical aortic valve replacement or transcather aortic valve implantation with an overestimation of risk using ACEF and conversely an overestimation of it using EUROSCORE or STS score [3].The limitations of these risk models reside on their conceptualization and structure, mainly focused on cardiac specific parameters, and consequently in their inability to capture biological and functional vulnerability present in elderly patient and summarized by FRAILTY concept [4].

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The Changing Face of Cardiac Surgery: Practice Patterns and Outcomes 2001-2010

Cited by 50 publications

References 21 publications

Regional differences in aortic valve replacements: Atlantic Canadian experience

Regional differences in aortic valve replacements: Atlantic Canadian experience

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly

Cardiac surgery in the elderly: What goals of care?

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