CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.004
{"title":"The Potential for Heart Donation After Death Determination by Circulatory Criteria in the Province of Québec","authors":"","doi":"10.1016/j.cjco.2024.05.004","DOIUrl":"10.1016/j.cjco.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>Heart donation (HD) by those with death determination by circulatory criteria (DDCC) has been proposed as a method to increase the heart donor pool in response to the growing need for heart transplantation (HT). However, the potential level of HD after DDCC in the province of Québec has not yet been reported. This study aims to assess the suitability for HD among donors with DDCC, and to estimate its impact on HT activity.</p></div><div><h3>Methods</h3><p>Donation records by those with DDCC in the province of Québec, from January 2016 to December 2020, were retrospectively reviewed for donor and predonation characteristics. Predetermined exclusion criteria were used to evaluate eligibility for HD.</p></div><div><h3>Results</h3><p>Of the 122 patients with DDCC who were included, 42 (34%) were identified as potentially-eligible heart donors. The median age of potentially-eligible donors was 52 years; 60% were female; and the most prevalent causes leading to organ donation in this group were medical aid in dying (26%), traumatic brain injury (26%), and anoxia (24%). A 19% increase (42 of 225) in potential HT activity was estimated using strict criteria. In only one case did functional warm ischemia time exceed the 30-minute limit.</p></div><div><h3>Conclusions</h3><p>Using those with DDCC as a new source of heart donors can significantly increase the volume of heart donation in the province of Québec. Implementing an HD program for those with DDCC in Québec may reduce waiting time and increase the number of heart recipients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002142/pdfft?md5=87bac081bee735d5a8b8075151b1711b&pid=1-s2.0-S2589790X24002142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.010
{"title":"Outcome of Percutaneous and Surgical Management for Tricuspid Infective Endocarditis: Insights From a National Study","authors":"","doi":"10.1016/j.cjco.2024.05.010","DOIUrl":"10.1016/j.cjco.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of infective endocarditis (IE) and its associated mortality rates remain high, despite medical advances. In recent years, treatment options for IE have expanded, but they are yet to be widely utilized. The current study aimed to compare in-hospital outcomes of high-risk tricuspid valve (TV) IE patients, by treatment strategy.</p></div><div><h3>Methods</h3><p>Patients from the National Inpatient Sample 2017-2019 database who had TV IE were grouped by therapy type—percutaneous aspiration, surgical, or conservative management. Patients were considered to be at high risk if they underwent mechanical intervention or if they had right ventricle failure or septic emboli.</p></div><div><h3>Results</h3><p>The analyzed cohort consisted of 28,495 patients—1.7% were treated with percutaneous aspiration, 13.5% with surgery, and 84.6% conservatively. Patients treated with percutaneous aspiration had the highest prevalence of septic shock and acute respiratory failure (<em>P</em> < 0.001). The overall in-hospital mortality rate was 7%. Patients treated conservatively had higher in-hospital mortality rates (7.5%) compared to those of the surgical group (4.4%) and the percutaneous aspiration group (4.1%; <em>P</em> < 0.001). In a multivariate analysis, conservative management was associated with an increased risk of in-hospital mortality (odds ratio 2.853, 95% confidence interval 1.748-4.659, <em>P</em> < 0.001), and no significant difference was found between the aspiration and surgical groups (<em>P</em> = 0.346). Benefits were pronounced in younger patients and those with septic shock or respiratory failure. Patients in the aspiration group had the highest rate of home discharge with self-care, of the various patient dispositions (<em>P</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Among high-risk patients with TV IE, an invasive approach is associated with a significantly lower in-hospital mortality rate than is a conservative approach, particularly in younger and unstable patients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002221/pdfft?md5=598d103dd222901d6751d4d41ef9b540&pid=1-s2.0-S2589790X24002221-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.06.004
{"title":"Acute Coronary Syndrome in a 40-Year-Old Man with Triglyceride Deposit Cardiomyovasculopathy: A Case Report","authors":"","doi":"10.1016/j.cjco.2024.06.004","DOIUrl":"10.1016/j.cjco.2024.06.004","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002543/pdfft?md5=86c0df3bf5f13ca425f05e6da1ec89ed&pid=1-s2.0-S2589790X24002543-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.007
{"title":"Long-term Monitoring to Detect Risk of Sudden Cardiac Death in Inherited Arrhythmia Patients","authors":"","doi":"10.1016/j.cjco.2024.05.007","DOIUrl":"10.1016/j.cjco.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><p>Risk stratification in inherited arrhythmia syndromes is challenging. Implantable cardioverter defibrillators (ICDs) are effective in the prevention of sudden cardiac death but are associated with significant complications. We aimed to determine the value of long-term implantable loop recorder (ILR) monitoring to determine risk factors for arrhythmias in inherited arrhythmia patients.</p></div><div><h3>Methods</h3><p>We conducted a prospective multicentre study between 2015 and 2020 recruiting inherited arrhythmia probands and family members at intermediate arrhythmic risk, with no class 1 indication for ICD implantation. The primary endpoint was the detection by ILR of nonsustained ventricular tachycardia over ≥ 10 consecutive beats. Secondary endpoints included ICD insertion during follow-up, all-cause mortality, and ILR complication rates.</p></div><div><h3>Results</h3><p>A total of 45 individuals (30 female participants) were enrolled in the study. The most common diagnoses were long-QT syndrome (28%), Brugada syndrome (26%), and arrhythmogenic cardiomyopathy (11%). Following ILR insertion (mean follow-up 633 days; range, 387-969), cardiac symptoms occurred in 19 of 45 patients (42%), 5 of whom had nonsustained ventricular tachycardias (11%), which were symptomatic in 3 individuals. This situation led to ICD implantation based on ILR in 5 of 45 patients (11%). Fifty percent of symptomatic events occurred in ARVC patients. The median time from ILR insertion to ICD implantation was 152 days (interquartile range (25th, 75th percentiles) 55 of 209). No patient experienced sudden cardiac death.</p></div><div><h3>Conclusions</h3><p>ILRs enable the detection of high-risk arrhythmic features and facilitate selection of ICD candidates in inherited arrhythmia patients with borderline indications.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002178/pdfft?md5=c82271f86991dd2c2dbcf8399f970b24&pid=1-s2.0-S2589790X24002178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141139218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.012
{"title":"Prevalence, Patient Awareness, Treatment, and Control of Hypertension in Canadian Adults With Common Comorbidities","authors":"","doi":"10.1016/j.cjco.2024.05.012","DOIUrl":"10.1016/j.cjco.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.</p></div><div><h3>Methods</h3><p>Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.</p></div><div><h3>Results</h3><p>A total of 5,841,453 people, representing 23.0% (95% confidence interval [CI] 21.7%-24.2%) of Canadian adults, were hypertensive. The adjusted odds ratio (aOR) of having hypertension treated and controlled was higher in people with the following conditions, as compared to people without these conditions: a prior heart attack or stroke (aOR 3.15; 95% CI 2.31-4.31); dyslipidemia (aOR 2.51; 95% CI 1.96-3.21); obstructive sleep apnea (aOR 1.95; 95% CI 1.19-3.21); overweight or obesity (aOR 1.51; 95% CI 1.18-1.94); chronic kidney disease (aOR 1.49; 95% CI 1.13-1.95); and diabetes (aOR 1.44; 95% CI 1.12-1.86). Individuals without any of these comorbidities were less likely to have BP that is treated and controlled (aOR 0.34; 95% CI 0.25-0.48). Moreover, the prevalence of BP treatment and control was low among many people without prior heart attack or stroke, even those with a moderate (aOR 0.25; 95% CI 0.17-0.37) or high (aOR 0.10; 95% CI 0.06-0.16) Framingham risk.</p></div><div><h3>Conclusions</h3><p>Large differences in levels of BP control exist across comorbidity profiles, and the greatest gaps are seen in individuals without recognized comorbidities, even those who have a moderate-to-high Framingham risk. Efforts to optimize BP control and narrow care gaps, especially in individuals without recognized comorbidities, are necessary to reduce the burden of cardiovascular disease and premature death in Canada.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002245/pdfft?md5=411839c062bc84c37a80300dfaa9cec9&pid=1-s2.0-S2589790X24002245-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.008
{"title":"Time to Calm the Fick Down? A Systematic Review and Meta-Analysis of Thermodilution Compared to Direct Fick in Tricuspid Regurgitation","authors":"","doi":"10.1016/j.cjco.2024.05.008","DOIUrl":"10.1016/j.cjco.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><p>Many clinicians consider thermodilution (TD) as a means to measure cardiac output (CO) to be unreliable in patients with tricuspid regurgitation (TR). No systematic appraisals of this clinical issue have been conducted. We hypothesized that the level of inaccuracy of using TD in patients with TR, compared to the direct Fick (DF) method, to determine CO, is overstated.</p></div><div><h3>Methods</h3><p>We performed a systematic search of 6 major literature databases for the period from 1946 to July 2023. Studies were included if they included CO measurements determined with both TD and the DF method in patients with vs without TR. Meta-analysis of the correlation between the measurements determined by TD vs the DF method was performed, stratified by the presence of TR.</p></div><div><h3>Results</h3><p>A total of 1064 studies were identified, of which 8 met the inclusion criteria. Four of the studies were included in the pooled analysis. The presence of TR did not affect the correlation between CO measurements determined by TD vs the DF method (moderate-to-severe TR: <em>r</em> = 0.90, 95% confidence interval 0.76, 0.96; mild or no TR, <em>r</em> = 0.86, 95% confidence interval 0.71, 0.93). Many studies had high levels of heterogeneity and risk of bias.</p></div><div><h3>Conclusions</h3><p>The accuracy of CO measurements made using TD, compared to the gold-standard DF method, may not be meaningfully affected by the presence of moderate-to-severe TR. Given the high levels of heterogeneity and risk of bias of the included studies, these findings should be replicated in a modern cohort.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002191/pdfft?md5=6f931b75f8dde0578b1551625196e48d&pid=1-s2.0-S2589790X24002191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.06.005
{"title":"Approach to Right-Sided Chamber Dilatation in Cardiac Shunts: Part 1 of a 2-Part Series","authors":"","doi":"10.1016/j.cjco.2024.06.005","DOIUrl":"10.1016/j.cjco.2024.06.005","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002555/pdfft?md5=2f6278c7daf59e0c9cf7eff9eaccc443&pid=1-s2.0-S2589790X24002555-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.005
{"title":"Novel Noninvasive Index Combining Echocardiography and Computed Tomography for Screening for Pulmonary Hypertension in Patients With Systemic Sclerosis","authors":"","doi":"10.1016/j.cjco.2024.05.005","DOIUrl":"10.1016/j.cjco.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><p>In patients with systemic sclerosis (SSc), early detection of pulmonary hypertension (PH) improves survival. This study aimed to investigate whether a combination index (cPAT) of the tricuspid regurgitation jet peak gradient and the ratio of pulmonary artery (PA) diameter to aortic diameter measured by computed tomography (CT; PA ratio) can estimate the mean PA pressure (mPAP) and detect PH more accurately than conventional parameters in SSc patients.</p></div><div><h3>Methods</h3><p>A total of 36 SSc patients who underwent PH screening were retrospectively analyzed. All patients were screened for PH between 2013 and 2017 by echocardiography, CT, and right heart catheterization. Patients with mPAP > 20 mm Hg by right heart catheterization were diagnosed as having PH. Additionally, patients with an mPAP > 20 mm Hg, pulmonary vascular resistance > 2 Wood units, and PA wedge pressure ≤ 15 mm Hg, for whom other causes were ruled out, including group 2-5, were defined as having pulmonary atrial hypertension.</p></div><div><h3>Results</h3><p>Of 36 patients, 29 patients were female (81%), and the average duration of SSc was 7.5 years. The mPAP was significantly correlated with the tricuspid regurgitation jet peak gradient (<em>r</em> = 0.734), the PA ratio (<em>r</em> = 0.584), and the cPAT (<em>r</em> = 0.848). In receiver operating characteristic analysis to identify PH, the cPAT showed the highest area under the curve, 0.906, among the 3 parameters. Additionally, in receiver operating characteristic analysis to identify pulmonary atrial hypertension, the cPAT also showed the highest area under the curve, 0.851, among the 3 parameters.</p></div><div><h3>Conclusions</h3><p>The cPAT is a new index combining echocardiogram and CT results that provides the most accurate noninvasive assessment of mPAP in SSc patients. The cPAT can also help detect PH early in SSc patients, thereby allowing for earlier treatment.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002154/pdfft?md5=e2f47b5127e47dfc392362d60b354c76&pid=1-s2.0-S2589790X24002154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.05.013
{"title":"Sex Disparities in the Use and Outcomes of Septal Reduction Therapies for Obstructive Hypertrophic Cardiomyopathy","authors":"","doi":"10.1016/j.cjco.2024.05.013","DOIUrl":"10.1016/j.cjco.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Data are limited that examine potential sex-based disparities in the utilization and complications of septal reduction therapy (SRT) in patients with obstructive hypertrophic cardiomyopathy. Our aim was to assess the use and in-hospital outcomes of SRT, according to sex. We performed a retrospective cohort study using the 2017-2019 National Inpatient Sample database. Adult patients with obstructive hypertrophic cardiomyopathy were identified.</p></div><div><h3>Methods</h3><p>We assessed the use of SRT (surgical septal myectomy and alcohol septal ablation), according to sex. In those who underwent SRT, rates of in-hospital mortality, pacemaker implantation, implantable cardioverter defibrillator (ICD) implantation, ischemic stroke, major bleeding, and pericardial complication were assessed. All outcomes were compared between groups using inverse probability of treatment weighting (IPTW), adjusting for demographics, comorbidity burden, and hospital characteristics.</p></div><div><h3>Results</h3><p>In total, 72,680 weighted hospitalizations (median age: 67 years [range: 57-77]; 61% female patients) were included, and only 5.9% of patients underwent SRT. After IPTW adjustment, female patients were more likely to undergo SRT (adjusted risk ratio [aRR] 1.18, 95% confidence interval [95% CI] 1.03-1.36) and alcohol septal ablation (aRR 1.38, 95% CI 1.04-1.83). Likewise, female patients received pacemaker implantation more often (aRR 1.96, 95% CI 1.10-3.50) and ICD implantation (aRR 0.58, 95% CI 0.34-0.99) less frequently, compared with male patients. No differences were present in rates of surgical septal myectomy, in-hospital mortality, ischemic stroke, major bleeding, and pericardial complication between groups.</p></div><div><h3>Conclusions</h3><p>Our results suggest that female patients were slightly more likely to undergo SRT, especially alcohol septal ablation. In-hospital mortality and postprocedural complications were similar between the sexes, but women received more pacemaker implantation and less ICD implantation.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002257/pdfft?md5=d0b9ef5ef21e0f2c8ff7f2e35d9cbdf7&pid=1-s2.0-S2589790X24002257-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141277957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CJC OpenPub Date : 2024-09-01DOI: 10.1016/j.cjco.2024.04.012
{"title":"Total Arch vs Hemiarch Repair in Acute Type A Aortic Dissection: Systematic Review and Meta-Analysis of Comparative Studies","authors":"","doi":"10.1016/j.cjco.2024.04.012","DOIUrl":"10.1016/j.cjco.2024.04.012","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to compare the short- and long-term outcomes of total arch replacement (TAR) vs hemiarch replacement (HAR) in the management of acute type A aortic dissection.</p></div><div><h3>Methods</h3><p>We searched the literature for studies directly comparing TAR to HAR in acute type A aortic dissection. Hazard ratios (HRs) were extracted from digitized Kaplan-Meier curves.</p></div><div><h3>Results</h3><p>A total of 6526 patients were identified, of which 2060 (32%) had received a TAR. A total of 37% of patients were female, and the mean age (standard deviation) of the cohort was 59.8 ± 11.8 years. TAR patients had a higher prevalence of preoperative malperfusion (34% vs 26%). The TAR group had higher odds of 30-day mortality (4404 patients; odds ratio [OR] 1.79, 95% confidence interval [CI] 1.29-2.49), renal failure requiring dialysis (3475 patients; OR 1.34, 95% CI 1.02-1.76), and a trend toward higher rates of stroke (3292 patients; OR 1.49, 95% CI 0.93-2.39). No significant differences were observed in prevalence of permanent spinal cord injury, visceral ischemia, or reoperation for bleeding. The TAR group had a non–statistically significant increase in long-term mortality (4408 patients; HR 1.25, 95% CI 0.99-1.57), but showed a trend toward improved freedom from long-term aortic reoperation (1359 patients; HR 0.53; 95% CI 0.18-1.59). In a subgroup analysis, the hazard ratio of long-term mortality favoured TAR in only the subgroup of studies in which the difference in malperfusion was > 10% between groups.</p></div><div><h3>Conclusions</h3><p>TAR could be associated with improved freedom from long-term aortic reoperation but with potentially increased perioperative risks. We recommend a tailored surgical approach.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24002208/pdfft?md5=c73272a6f0a2fbc6e7fe18bf80857f1c&pid=1-s2.0-S2589790X24002208-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}