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Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis
http://www.jhltonline.org
ABSTRACTS
University, St. Louis, MO; 2University of Alabama at Birmingham, Birmingham, AL.
1( )
Purpose: Management of existing aortic insufficiency (AI) and mechanical aortic valves in patients undergoing left ventricular assist device (LVAD) implantation remains controversial. Surgical options to address these issues include closure, repair or replacement of the valve, but few data are available comparing short- or long-term outcomes for these strategies. Methods: Continuous flow LVAD/BiVAD patients entered into the INTERMACS database between June 2006 to December 2012 were included (n= 6,721). Outcomes were compared between patients who underwent aortic valve (AV) closure (n= 136), repair (n= 165) and replacement (n= 103). Results: Among patients that underwent an aortic valve procedure, actuarial survival was significantly reduced for AV closures (63%) compared to AV repairs (73%) and replacements (74%, p< 0.001). After multivariate adjustment, aortic valve closure remained a significant risk factor for mortality (HR= 1.95, 95% CI= 1.45-2.62, p< 0.0001). At six months postoperatively, moderate to severe AI developed in 21%, 15%, 7% and 10% of patients with available echocardiography who underwent repair, closure, replacement and no intervention, respectively (p< 0.0001). Competing outcomes demonstrate that at 1-year similar percentages of patients were transplanted regardless of whether they had a closure or repair/replacement (16% vs. 17%). A greater percentage of AV repair/replacement patients were alive with the device in place (51% vs. 59%) due to differences in mortality between groups. No differences were observed between groups with respect to cause of death, re-hospitalization, right heart failure or stroke. Conclusion: AV closure was associated with increased mortality when compared to repair or replacement in patients with AI that underwent LVAD insertion. The reasons for this association require further investigation, but this is the largest study to date to examine concomitant AV procedures in patients undergoing LVAD insertion.
The Scientific Impact of the Annual Meeting of the International Society for Heart & Lung Transplantation D. Schibilsky ,1 C. Haller,1 B. Woernle,1 T. Krueger,1 A. Glanville,2 H. Reichenspurner,3 D. Taylor,4 M. Mehra,5 T. Walker,1 U. Eriksson,6 C.M. Matter,7 F. Ruschitzka,7 T. Lüscher,7 C. Schlensak,1 S. Winnik.7 1Department of Thoracic and Cardiovascular Surgery, University Medical Center, Tuebingen, Germany; 2Department of Thoracic Medicine, St Vincent’s Hospital, Sydney, Australia; 3Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany; 4Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; 5Collaborative Center for Advanced Heart Disease, Brigham and Womens Hospital, Boston, MA; 6Division of Cardiology and Department of Medicine, GZO-Zurich Regional Health Centre, Wetzikon, Switzerland; 7Department of Cardiology, University Heart Center, Zurich, Switzerland. Purpose: To assess the scientific impact of the studies presented at the Annual Meeting for the International Society for Heart and Lung Transplantation (ISHLT) and to identify predictors of later publication and citation. To describe and improve current and future scientific, editorial and review work. Methods: In this bibliometric study all 777 abstracts submitted to the ISHLT meeting 2008 (accepted & rejected studies) were analyzed. We characterized the research itself, its origin and researchers, and followed all studies for a period of 5 years for later publication in a peer-reviewed journal and subsequent citation. Results: 777 abstracts were submitted from 31 different countries of all 5 continents. 68.1% of these studies were accepted for presentation, yielding 260 peer-reviewed publications and a total of 3966 citations. Studies that had been accepted for presentation had a higher publication rate compared with studies that had been rejected (35.8% vs 28.6%, p= 0.029). Among accepted studies, those accepted for oral presentation were published more frequently than those that had been accepted for poster presentation (49.2% vs 31.1%). 87.9% of all studies were submitted from academic institutions, only 30% involved 2 or more institutions, 64.9% involved 2 or more different disciplines, whereas 19.4% were performed by 2 or more centers. 83.7% of all abstracts submitted were clinical studies, among those 92.6% were observational, only 7.4% had an interventional study design. Binary logistic regression analyses revealed an academic affiliation (OR 1.99, 95% CI 1.16-3.43), multi-center studies involving 2 or more centers (OR 1.62, 95% CI 1.11-2.37) and a study design of prospective cohort studies (OR 2.86, 95% CI 1.04-7.91) as independent predictors of later full-text publication in a peer-reviewed journal. Clinical studies with an enrollment 150 or more patients (OR 3.26, 95% CI 1.80-5.90) and studies involving 3 or more different disciplines were identified as independent predictors to reach the top 25% and top 10% of the most cited studies, respectively. Conclusion: Scientific impact was determined by distinct factors including collaborations between different centers and disciplines as well as a prospective study design. These findings underline the importance of the ISHLT as an international and interdisciplinary research forum of high scientific impact. 2( ) Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis J.O. Robertson ,1 S.L. Meyers,2 J.K. Kirklin,2 G.D. Mertz,2 S. Prasad,1 A. Itoh,1 S.C. Silvestry.1 1Division of Cardiothoracic Surgery, Washington
1053-2498/$ - see front matter http://dx.doi.org/10.1016/j.healun.2013.01.002
3( ) Over 400% Increase in LVAD Thrombosis Reported to the FDA’s Manufacturer and User Facility Device Experience (MAUDE) Database from 2010 to 2012 J.X. Wang ,1 E.H. Lee,1 P. Bonde.2 1Bonde Artificial Heart Lab, Yale University School of Medicine, New Haven, CT; 2Cardiovascular Surgery, Yale University School of Medicine, New Haven, CT. Purpose: To investigate the frequency of device thrombosis in continuousflow left ventricular assist devices (CF-LVAD) over time as reported by the FDA-operated MAUDE database for post-market surveillance.
ABSTRACTS
University, St. Louis, MO; 2University of Alabama at Birmingham, Birmingham, AL.
1( )
Purpose: Management of existing aortic insufficiency (AI) and mechanical aortic valves in patients undergoing left ventricular assist device (LVAD) implantation remains controversial. Surgical options to address these issues include closure, repair or replacement of the valve, but few data are available comparing short- or long-term outcomes for these strategies. Methods: Continuous flow LVAD/BiVAD patients entered into the INTERMACS database between June 2006 to December 2012 were included (n= 6,721). Outcomes were compared between patients who underwent aortic valve (AV) closure (n= 136), repair (n= 165) and replacement (n= 103). Results: Among patients that underwent an aortic valve procedure, actuarial survival was significantly reduced for AV closures (63%) compared to AV repairs (73%) and replacements (74%, p< 0.001). After multivariate adjustment, aortic valve closure remained a significant risk factor for mortality (HR= 1.95, 95% CI= 1.45-2.62, p< 0.0001). At six months postoperatively, moderate to severe AI developed in 21%, 15%, 7% and 10% of patients with available echocardiography who underwent repair, closure, replacement and no intervention, respectively (p< 0.0001). Competing outcomes demonstrate that at 1-year similar percentages of patients were transplanted regardless of whether they had a closure or repair/replacement (16% vs. 17%). A greater percentage of AV repair/replacement patients were alive with the device in place (51% vs. 59%) due to differences in mortality between groups. No differences were observed between groups with respect to cause of death, re-hospitalization, right heart failure or stroke. Conclusion: AV closure was associated with increased mortality when compared to repair or replacement in patients with AI that underwent LVAD insertion. The reasons for this association require further investigation, but this is the largest study to date to examine concomitant AV procedures in patients undergoing LVAD insertion.
The Scientific Impact of the Annual Meeting of the International Society for Heart & Lung Transplantation D. Schibilsky ,1 C. Haller,1 B. Woernle,1 T. Krueger,1 A. Glanville,2 H. Reichenspurner,3 D. Taylor,4 M. Mehra,5 T. Walker,1 U. Eriksson,6 C.M. Matter,7 F. Ruschitzka,7 T. Lüscher,7 C. Schlensak,1 S. Winnik.7 1Department of Thoracic and Cardiovascular Surgery, University Medical Center, Tuebingen, Germany; 2Department of Thoracic Medicine, St Vincent’s Hospital, Sydney, Australia; 3Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany; 4Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; 5Collaborative Center for Advanced Heart Disease, Brigham and Womens Hospital, Boston, MA; 6Division of Cardiology and Department of Medicine, GZO-Zurich Regional Health Centre, Wetzikon, Switzerland; 7Department of Cardiology, University Heart Center, Zurich, Switzerland. Purpose: To assess the scientific impact of the studies presented at the Annual Meeting for the International Society for Heart and Lung Transplantation (ISHLT) and to identify predictors of later publication and citation. To describe and improve current and future scientific, editorial and review work. Methods: In this bibliometric study all 777 abstracts submitted to the ISHLT meeting 2008 (accepted & rejected studies) were analyzed. We characterized the research itself, its origin and researchers, and followed all studies for a period of 5 years for later publication in a peer-reviewed journal and subsequent citation. Results: 777 abstracts were submitted from 31 different countries of all 5 continents. 68.1% of these studies were accepted for presentation, yielding 260 peer-reviewed publications and a total of 3966 citations. Studies that had been accepted for presentation had a higher publication rate compared with studies that had been rejected (35.8% vs 28.6%, p= 0.029). Among accepted studies, those accepted for oral presentation were published more frequently than those that had been accepted for poster presentation (49.2% vs 31.1%). 87.9% of all studies were submitted from academic institutions, only 30% involved 2 or more institutions, 64.9% involved 2 or more different disciplines, whereas 19.4% were performed by 2 or more centers. 83.7% of all abstracts submitted were clinical studies, among those 92.6% were observational, only 7.4% had an interventional study design. Binary logistic regression analyses revealed an academic affiliation (OR 1.99, 95% CI 1.16-3.43), multi-center studies involving 2 or more centers (OR 1.62, 95% CI 1.11-2.37) and a study design of prospective cohort studies (OR 2.86, 95% CI 1.04-7.91) as independent predictors of later full-text publication in a peer-reviewed journal. Clinical studies with an enrollment 150 or more patients (OR 3.26, 95% CI 1.80-5.90) and studies involving 3 or more different disciplines were identified as independent predictors to reach the top 25% and top 10% of the most cited studies, respectively. Conclusion: Scientific impact was determined by distinct factors including collaborations between different centers and disciplines as well as a prospective study design. These findings underline the importance of the ISHLT as an international and interdisciplinary research forum of high scientific impact. 2( ) Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis J.O. Robertson ,1 S.L. Meyers,2 J.K. Kirklin,2 G.D. Mertz,2 S. Prasad,1 A. Itoh,1 S.C. Silvestry.1 1Division of Cardiothoracic Surgery, Washington
1053-2498/$ - see front matter http://dx.doi.org/10.1016/j.healun.2013.01.002
3( ) Over 400% Increase in LVAD Thrombosis Reported to the FDA’s Manufacturer and User Facility Device Experience (MAUDE) Database from 2010 to 2012 J.X. Wang ,1 E.H. Lee,1 P. Bonde.2 1Bonde Artificial Heart Lab, Yale University School of Medicine, New Haven, CT; 2Cardiovascular Surgery, Yale University School of Medicine, New Haven, CT. Purpose: To investigate the frequency of device thrombosis in continuousflow left ventricular assist devices (CF-LVAD) over time as reported by the FDA-operated MAUDE database for post-market surveillance.