Showing papers by "A. Pieter Kappetein published in 2013"

Guidelines on the Management of Valvular Heart disease (Version 2012)

Abstract: Authors/Task Force Members, Alec Vahanian (Chairperson) Paris (France)*, Helmut Baumgartner, Vienna (Austria), Jeroen Bax, Leiden (The Netherlands), Eric Butchart, Cardiff (UK), Robert Dion, Leiden (The Netherlands), Gerasimos Filippatos, Athens (Greece), Frank Flachskampf, Erlangen (Germany), Roger Hall, Norwich (UK), Bernard Iung, Paris (France), Jaroslaw Kasprzak, Lodz (Poland), Patrick Nataf, Paris (France), Pilar Tornos, Barcelona (Spain), Lucia Torracca, Milan (Italy), Arnold Wenink, Leiden (The Netherlands)

Coronary artery bypass grafting: Part 1--the evolution over the first 50 years.

Abstract: Surgical treatment for angina pectoris was first proposed in 1899. Decades of experimental surgery for coronary artery disease finally led to the introduction of coronary artery bypass grafting (CABG) in 1964. Now that we are approaching 50 years of CABG experience, it is appropriate to summarize the advancement of CABG into a procedure that is safe and efficient. This review provides a historical recapitulation of experimental surgery, the evolution of the surgical techniques and the utilization of CABG. Furthermore, data on contemporary clinical outcomes are discussed.

A systematic review of risk prediction in adult cardiac surgery: considerations for future model development

Abstract: OBJECTIVES: Risk prediction in adult patients undergoing cardiac surgery remains inaccurate and should be further improved. Therefore, we aimed to identify risk factors that are predictive of mortality, stroke, renal failure and/or length of stay after adult cardiac surgery in contemporary practice. METHODS: We searched the Medline database for English-language original contributions from January 2000 to December 2011 to identify preoperative independent risk factors of one of the following outcomes after adult cardiac surgery: death, stroke, renal failure and/or length of stay. Two investigators independently screened the studies. Inclusion criteria were (i) the study described an adult cardiac patient population; (ii) the study was an original contribution; (iii) multivariable analyses were performed to identify independent predictors; (iv) ≥1 of the predefined outcomes was analysed; (v) at least one variable was an independent predictor, or a variable was included in a risk model that was developed. RESULTS: The search yielded 5768 studies. After the initial title screening, a second screening of the full texts of 1234 studies was performed. Ultimately, 844 studies were included in the systematic review. In these studies, we identified a large number of independent predictors of mortality, stroke, renal failure and length of stay, which could be categorized into variables related to: disease pathology, planned surgical procedure, patient demographics, patient history, patient comorbidities, patient status, blood values, urine values, medication use and gene mutations. Many of these variables are frequently not considered as predictive of outcomes. CONCLUSIONS: Risk estimates of mortality, stroke, renal failure and length of stay may be improved by the inclusion of additional (non-traditional) innovative risk factors. Current and future databases should consider collecting these variables.

The European Association for Cardio-Thoracic Surgery (EACTS) database: an introduction

Abstract: OBJECTIVES: Continuous monitoring of surgical outcomes through benchmarking and the identification of best practices has become increasingly important. A structured approach to data collection, coupled with validation, analysis and reporting, is a powerful tool in these endeavours. However, inconsistencies in standards and practices have made comparisons within and between European countries cumbersome. The European Association for Cardio-Thoracic Surgery (EACTS) has established a large international database with the goals of (i) working with other organizations towards universal data collection and creating a European-wide repository of information on the practice of cardio-thoracic surgery, and (ii) disseminating that information in scientific, peer-reviewed articles. We report on the process of data collection, as well as on an overview of the data in the database. METHODS: The EACTS Database Committee met for the first time in Monaco, September 2002, to establish the ground rules for the process of setting up the database. Subsequently, data have been collected and merged by Dendrite Clinical Systems Ltd. RESULTS: As of December 2008, the database included 1 074 168 patient records from 366 hospitals located in 29 countries. The latest submission from the years 2006–08 included 404 721 records. The largest contributors were the UK (32.0%), Germany (20.9%) and Belgium (7.3%). Isolated coronary bypass surgery was the most frequently performed operation; the proportion of surgical workload that comprised isolated coronary artery bypass grafting varied from country to country: 30% in Spain and almost 70% in Denmark. Isolated valve procedures constituted 12% of all procedures in Norway and 32% in Spain. Baseline demographics showed an increase in the mean age and the percentage of patients that were female over time. Remarkably, the mortality rates for all procedures declined over the period analysed, to 2.2% (95% confidence interval [CI] 2.2–2.3%) for isolated coronary bypass, 3.4% (95% CI 3.3–3.5%) for isolated valve and 6.2% (95% CI 6.0–6.5%) for bypass + valve procedures. CONCLUSION: The EACTS database has proven to be an important step forward in providing opportunities for monitoring cardiac surgical care across Europe. As the database continues to expand, it will facilitate research projects, establish benchmarking standards and identify potential areas for quality improvements.

Editorial Comment: The role of EuroSCORE II in 21st century cardiac surgery practice

Abstract: West Quality Improvement Programme in Cardiac Interventions. The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk? Heart 2006;92:1817–20. [16] Ranucci M, Castelvecchio S, Menicanti LA, Scolletta S, Biagioli B, Giomarelli P. An adjusted EuroSCORE model for high-risk cardiac patients. Eur J Cardiothorac Surg 2009;36:791–7. [17] Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation 2009;119: 3053–61. [18] Ranucci M, Castelvecchio S, Conte M, Megliola G, Speziale G, Fiore F et al. The easier, the better: age, creatinine, ejection fraction score for operative mortality risk stratification in a series of 29,659 patients undergoing elective cardiac surgery. J Thorac Cardiovasc Surg 2011;142:581–6. [19] Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41. [20] Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;8:307–10. [21] Ad N, Barnett SD, Speir AM. The performance of the EuroSCORE and the Society of Thoracic Surgeon mortality risk score: the gender factor. Interact CardioVasc Thorac Surg 2007;6:192–5. [22] Zingone B, Pappalardo A, Dreas L. Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample. Eur J Cardiothoracic Surg 2004;26:1134–40. [23] Filsoufi F, Salzberg SP, Rahmanian PB, Schiano TD, Elsiesy H, Squire A et al. Early and late outcome of cardiac surgery in patients with liver cyrrhosis. Liver Transpl 2007;13:990–5. [24] Modi A, Vohra HA, Barlow CW. Do patients with liver cirrhosis undergoing cardiac surgery have acceptable outcomes? Interact CardioVasc Thorac Surg 2010;11:630–4. [25] Osswald BR, Blackstone EH, Tochtermann U, Thomas G, Vahl CF, Hagl S. The meaning of early mortality after CABG. Eur J Cardiothorac Surg 1999;15:401–7.

Subgroup analyses in trial reports comparing percutaneous coronary intervention with coronary artery bypass surgery

Abstract: Subgroup Analyses in Trial Reports Comparing Percutaneous Coronary Intervention With Coronary Artery Bypass Surgery Subgroup analyses within randomized clinical trials (RCTs) may not be valid,1,2 although they may identify important treatment heterogeneity. Reviews of subgroup analyses in primary reports of RCTs have found low credibility due to methodological or reporting issues.2 Subgroup analyses may also be presented in separate reports of extended follow-up beyond the primary end point or specific subgroups of patients. No data are available on the quality of subgroup analyses in these subsequent reports. We evaluated subgroup analyses in reports from RCTs comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG).

Multivessel coronary artery disease: quantifying how recent trials should influence clinical practice.

Abstract: The majority (70%) of coronary revascularizations concern patients with multivessel disease (MVD). Treatment options include medical therapy, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). CABG surgery has been shown to improve survival compared with medical therapy. PCI relieves angina compared with medical therapy and is equivalent to CABG in low complex MVD. Other benefits are currently being evaluated in ongoing trials. In complex MVD, CABG results in lower rates of long-term mortality, myocardial infarction and repeat revascularization compared with PCI. These results are more pronounced in diabetics and in patients with lesions that are anatomically more complex. The application of the results of clinical trials may be limited due to restrictive eligibility criteria. Comparative effectiveness studies are, therefore, needed to complement the results of trials, but also have inherent limitations. Inappropriateness criteria provide an important tool to measure how evidence from trials, large registries and guidelines is integrated in clinical practice. Checklists and decision aids may also lead to better application of the latest evidence and lower rates of inappropriate use. Decision-making is centered around heart team discussions and risk scores. Economic considerations will increasingly be included in decision-making, since the economic impact of ischemic heart disease is high and the growth of healthcare expenditure is unsustainable. In this context, CABG is associated with higher upfront costs, but is economically attractive at long-term follow-up.

Guía de práctica clínica sobre el tratamiento de las valvulopatías (versión 2012)

Abstract: Autores/Miembros del Grupo de Trabajo: Alec Vahanian (Coordinador) (Francia)*, Ottavio Alfieri (Coordinador)* (Italia), Felicita Andreotti (Italia), Manuel J. Antunes (Portugal), Gonzalo Baron-Esquivias (Espana), Helmut Baumgartner (Alemania), Michael Andrew Borger (Alemania), Thierry P. Carrel (Suiza), Michele De Bonis (Italia), Arturo Evangelista (Espana), Volkmar Falk (Suiza), Bernard Iung (Francia), Patrizio Lancellotti (Belgica), Luc Pierard (Belgica), Susanna Price (Reino Unido), Hans-Joachim Schafers (Alemania), Gerhard Schuler (Alemania), Janina Stepinska (Polonia), Karl Swedberg (Suecia), Johanna Takkenberg (Paises Bajos), Ulrich Otto Von Oppell (Reino Unido), Stephan Windecker (Suiza), Jose Luis Zamorano (Espana) y Marian Zembala (Polonia)

Failing surgical bioprosthesis in aortic and mitral position

Abstract: Bioprosthetic heart valves are preferentially selected over mechanical prostheses in the majority of patients undergoing valve replacement surgery. These bioprostheses are prone to structural degeneration, and hence an increasing number of patients are presenting with bioprosthetic failure requiring redo surgery. In selected high-risk cases, successful implantation of a transcatheter aortic valve (TAV) within the failing bioprosthetic surgical aortic valve (SAV) or mitral valve (SMV) has been performed. Herein, we summarise the available evidence, describe the technical challenges, and highlight important procedural considerations for these innovative interventions.