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Department of Cardiothoracic Surgery

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https://hdl.handle.net/1813/116679

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Now showing 1 - 9 of 9
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    Time to Assess the Role of Quality Control in CABG: the SMARTFLOW trial program
    Gaudino, M.; Sandner, S.; Voisine, P.; Glineur, D.; Redfors, B.; Verma, S. (Oxford University Press, 2025-11-29)
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    Meta-Analysis of Coronary Bypass Graft Patency Assessment With Invasive vs Computed Tomographic Angiography.
    Mantaj, P.; Hirofuji, A.; Dell'Aquila, M.; Demetres, M.; Gregg, A.; Krieger, K.; Abdalla, S.; Kennedy, M.; Savic, M.; Ahmadi-Hadad, A.; Rossi, C.S.; Soletti, G.; Nikolikj, A.; Rahouma, M.; Sandner, S.; Gaudino, M. (Elsevier, 2025-07-01)
    BACKGROUND: Computed tomography (CT) coronary angiography has emerged as a non-invasive alternative for evaluating graft patency after coronary artery bypass grafting (CABG), but there is ongoing debate regarding its diagnostic performance compared to invasive coronary angiography, particularly for arterial and composite grafts. METHODS: MEDLINE, Embase, and Cochrane databases were searched to identify studies comparing CT coronary angiography to invasive coronary angiography for detection of graft occlusion in post-CABG patients. Outcomes included sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Meta-regression explored key modifiers. Pooled estimates were calculated using random-effects models, with heterogeneity measured via I2. RESULTS: Fifty studies met inclusion criteria, including 3,449 patients (25% women). CT coronary angiography sensitivity for graft occlusion was 0.96 (I2 = 48%), specificity was 0.97 (I2 = 46%), positive predictive value was 0.94 (I2 = 62%), negative predictive value was 0.98 (I2 = 41%) and overall diagnostic accuracy was 0.97 (I2 = 58%). The pooled incidence rate of graft occlusion across 7,506 included grafts was 0.08 per graft-year (PGY) (95% CI: 0.06-0.10) using a random-effects model, and 0.07 PGY (95% CI: 0.07-0.08). At meta-regression, study year, sample size, β-blocker use, number of slices, and time since surgery, but not type and configuration of CABG grafts, were significantly associated with CT coronary angiography sensitivity. CONCLUSIONS: CT coronary angiography detects coronary artery bypass graft occlusion with a high degree of sensitivity and specificity independently of graft type and configuration and can be used for imaging of every type of CABG graft.
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    Meta-Analysis of Coronary Bypass Graft Patency Assessment With Invasive vs Computed Tomographic Angiography
    Mantaj, P.; Hirofuji, A.; Dell'Aquila, M.; Demetres, M.; Gregg, A.; Krieger, K.; Abdalla, S.; Kennedy, M.; Savic, M.; Ahmadi-Hadad, A.; Rossi, C.S.; Soletti, G.; Nikolikj, A.; Rahouma, M.; Sandner, S.; Gaudino, M. (Elsevier, 2025-07-01)
    BACKGROUND: Computed tomography (CT) coronary angiography has emerged as a non-invasive alternative for evaluating graft patency after coronary artery bypass grafting (CABG), but there is ongoing debate regarding its diagnostic performance compared to invasive coronary angiography, particularly for arterial and composite grafts. METHODS: MEDLINE, Embase, and Cochrane databases were searched to identify studies comparing CT coronary angiography to invasive coronary angiography for detection of graft occlusion in post-CABG patients. Outcomes included sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Meta-regression explored key modifiers. Pooled estimates were calculated using random-effects models, with heterogeneity measured via I2. RESULTS: Fifty studies met inclusion criteria, including 3,449 patients (25% women). CT coronary angiography sensitivity for graft occlusion was 0.96 (I2 = 48%), specificity was 0.97 (I2 = 46%), positive predictive value was 0.94 (I2 = 62%), negative predictive value was 0.98 (I2 = 41%) and overall diagnostic accuracy was 0.97 (I2 = 58%). The pooled incidence rate of graft occlusion across 7,506 included grafts was 0.08 per graft-year (PGY) (95% CI: 0.06-0.10) using a random-effects model, and 0.07 PGY (95% CI: 0.07-0.08). At meta-regression, study year, sample size, β-blocker use, number of slices, and time since surgery, but not type and configuration of CABG grafts, were significantly associated with CT coronary angiography sensitivity. CONCLUSIONS: CT coronary angiography detects coronary artery bypass graft occlusion with a high degree of sensitivity and specificity independently of graft type and configuration and can be used for imaging of every type of CABG graft.
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    Randomized Trials in Cardiac Surgery: Why and How
    Gaudino, M.; Siepe, M.; Murphy, G.J.; Williams, B.; Sandner, S.; Gregg, A.C.; Moskowitz, A.J.; Falk, V.; Gelijns, A.C. (Oxford University Press, 2025-06-03)
    OBJECTIVES: Randomised clinical trials (RCTs) are the gold standard for comparative effectiveness. However, they face unique challenges in cardiac surgery. The objective of this work is to summarize the challenges of RCTs in cardiac surgery, describe efforts employed in recent years to mitigate these impediments and outline the future opportunities for increased RCT adoption in the specialty. METHODS: This review was conducted as an expert analysis on the existing state of RCTs in cardiac surgery based on expert discussion at a dedicated session during the 2024 Annual Meeting of the European Association for Cardio-Thoracic Surgery (EACTS). Different trial-support infrastructures, such as the Randomized Comparison of the Clinical Outcomes of Single versus Multiple Arterial Grafts (ROMA) Network, the Cardiothoracic Trials Surgical Network (CTSN), the Global Cardiovascular Research Funders Forum (GCRFF) and the United Kingdom Model, and their respective mechanisms for overcoming RCT barriers were described in detailed. Models were selected due to specific author involvement and knowledge. Future directions were postulated based on current trends. RESULTS: Despite heterogeneous structures, the described models largely aimed to increased cardiac RCTs through improved trial participation, either via increased trainees, expanded stakeholders or focused patient recruitment, facilitating funding and fostering wider collaboration. CONCLUSIONS: RCTs are a key component for clinical advancement yet have been underutilized in cardiac surgery. Recent endeavors have reduced the multifactorial barriers associated with cardiac surgery RCTs and intentional future efforts are necessary for continued cardiac advancement.
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    Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial
    Caldonazo, T.; Rahouma, M.; Sandner, S.; Redfors, B.; Harik, L.; Richter, M.; Kirov, H.; Doenst, T.; Gaudino, M.F.L. (Wiley, 2025-06-27)
    BACKGROUND: The fibrosis-4 index (FIB-4) score, a noninvasive marker of subclinical liver fibrosis, has shown prognostic utility in general surgical populations. Current risk assessment models for patients with coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting do not account for liver dysfunction apart from overt liver cirrhosis. We analyzed the distribution of the baseline FIB-4 score and its association with all-cause death in patients with coronary artery disease using data from the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial. METHODS: The baseline FIB-4 score was calculated for all ISCHEMIA randomized participants with laboratory data (platelet count, aspartate aminotransferase, and alanine aminotransferase). The primary outcome was the association between baseline FIB-4 and all-cause death. Secondary outcomes were cardiovascular death, heart failure, myocardial infarction, and stroke. Multivariable Cox regression was performed adjusting for key risk factors. RESULTS: The FIB-4 score was calculated for 3735 participants. Baseline FIB-4 score was significantly associated with an increased risk of all-cause (hazard ratio [HR], 1.19 [95% CI, 1.07-1.32]; P=0.001) and cardiovascular death (HR, 1.19 [95% CI, 1.04-1.36]; P=0.011). This association was consistent across the overall population and within subgroups of patients treated with percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy. There was no significant association regarding heart failure, myocardial infarction, and stroke. CONCLUSIONS: The FIB-4 score may be a significant predictor of death in patients with coronary artery disease. Preprocedural hepatic assessment should be considered to stratify risk in patients undergoing invasive cardiac procedures.
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    Novel Implementation of Hepatitis B to Hepatitis Delta Reflex Testing in a United States Healthcare System.
    Mageras, A.; Rodriguez, N.; Katzenstein, C.; Lee, F.; Alpert, L.; Branch, A.D.; Zhang, X.; Dieterich, D.T.; Kushner, T. (Lippincott, Williams & Wilkins, 2025-07-31)
    OBJECTIVES: Hepatitis delta virus (HDV) is the most aggressive form of viral hepatitis, yet screening rates in the United States are low, and few institutions have attempted interventions to improve the screening cascade. We assessed barriers to reflex test implementation, including lack of an FDA-approved reflex test, and implemented hepatitis B surface antigen (HBsAg) to HDV antibody (HDV Ab) reflex testing in our large, urban, academic healthcare system. METHODS: We evaluated outcomes one year after implementation using summary statistics. Patient- and clinic-level characteristics were investigated for association with receiving a reflex test versus standalone using multivariable logistic regression. RESULTS: All patients with a reflex order and HBsAg-positive result received HDV Ab follow-up testing, and their time to HDV Ab result was significantly shorter than for those whose HDV test required a separate order (2 versus 11 days, p < 0.0001). Uptake of the reflex order was highest in primary care, where it was embedded into existing workflows. CONCLUSIONS: Reflex testing improved efficiency and reduced gaps in the HBsAg to HDV screening cascade. Disparities in reflex testing rates among different patient groups were found, highlighting the need for universal reflex testing.
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    Planned versus emergency coronary artery bypass grafting during elective aortic root replacement: short- and long-term outcomes.
    Ram, E.; Lau, C.; Gregg, A.; Harik, L.; Soletti, G.; Gaudino, M.; Girardi, L.N. (Oxford University Press, 7/30/25)
    OBJECTIVES: Evaluate the impact of coronary artery bypass grafting (CABG) on outcomes in patients undergoing aortic root replacement (ARR). METHODS: This was a retrospective cohort study of patients undergoing elective ARR at a single high-volume center. Patients were stratified based on whether they underwent concomitant CABG, and outcomes were compared using multivariable regression and survival analysis. RESULTS: A total of 1518 patients (87.2%) underwent isolated ARR while 223 (12.8%) underwent ARR with CABG. A majority (N = 205, 91.9%) of CABG procedures were elective. In 18 patients (8.1%) CABG was needed emergently. Patients requiring CABG were older (64.8 ± 9.8 vs 55.1 ± 14.5 years, p < 0.001) with a greater incidence of comorbidities. Female sex [OR 4.54 (1.57-12.62), p = 0.004] and smaller aortic root size [OR 0.34 (0.16-0.75), p = 0.007] were associated with need for emergency CABG on multivariable analysis. Operative mortality (OM) was significantly higher in all patients needing concomitant CABG [1.8% vs 0.2%; OR 6.08 (1.16-35.3), p = 0.032]. Among those needing CABG, emergency CABG patients had a higher OM than elective CABG [11.1% vs 1%; OR 12.5 (1.45-100), p = 0.014]. Respiratory complications were more common after emergency CABG as was the incidence of postoperative renal dysfunction and a composite of major adverse events. 10-year survival for all patients requiring CABG was not significantly compromised [73.8% vs 86.2%, HR 0.98, (0.6-1.59), p = 0.937]. CONCLUSIONS: Elective and emergency CABG increase operative risk but do not reduce long-term survival in patients undergoing ARR. Females and those with small aortic roots are at particular risk for needing emergency CABG.
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    Association Between Short-Term Change in Quality of Life and Clinical Outcomes: A Post Hoc Analysis of the ISCHEMIA Trial.
    Caldonazo, T.; Kim, J.; Heise, R.; Rahouma, M.; Harik, L.; Redfors, B.; Sandner, S.; Doenst, T.; Gaudino, M.F.L. (Wiley, 3/27/25)
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    Statin Use Among Women and Men Following Coronary Artery Bypass Surgery.
    Sandner, S.; Kaider, A.; Riebandt, J.; Florian, A.; Rizvanovic, S.; Bairey Merz, C.N.; Lawton, J.S.; Charlson, M.; Safford, M.M.; Bergmair, T.; Zuckermann, A.; Gaudino, M. (Wiley, 3/26/25)
    BACKGROUND: Limited data exist on sex differences in guideline-recommended statin therapy for secondary prevention after coronary artery bypass surgery (CABG). We examined sex differences in statin use after CABG and the association between sex-specific statin use and mortality. METHODS AND RESULTS: Data from the Austrian national cardiac surgery registry and federal social insurance claims database for patients who underwent CABG between 2013 and 2021 were used. Multivariable logistic regression models were calculated to obtain women-to-men odds ratios for filling any statin and high-intensity statin prescriptions. Cox proportional hazards models were used to evaluate the association between statin use and mortality. A total of 15 448 patients (19% women) were included. During the 5 years after CABG, statin use decreased from 95.7% to 85.9% in men and 95.2% to 84.3% in women (P for trend <0.0001; Pint=0.48), high-intensity statin use decreased from 69.4% to 57.2% in men and 67.8% to 54.3% in women (P for trend <0.0001; Pint=0.59). The adjusted odds ratio for filling any statin prescription comparing women with men was 1.03 (95% CI, 0.92-1.16) and for filling a high-intensity statin prescription was 1.12 (95% CI, 1.02-1.23). Statin use was associated with a significantly lower mortality risk in both sexes (any statin: hazard ratio [HR], 0.56 [95% CI, 0.46-0.68]; P<0.0001, Pint=0.22; high-intensity statin: HR, 0.52 [95% CI, 0.42-0.63]; P<0.0001, Pint=0.48). CONCLUSIONS: Women were as likely as men to fill a statin prescription after CABG and more likely to fill a high-intensity prescription. Statin use was associated with a similar mortality risk reduction among women and men.