Browsing by Author "Gelijns, Annetine C"

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    Infarct‐related structural disconnection and delirium in surgical aortic valve replacement patients
    (Annals of Clinical and Translational Neurology) Browndyke, Jeffrey N; Tomalin, Lewis E; Erus, Guray; Overbey, Jessica R; Kuceyeski, Amy; Moskowitz, Alan J; Bagiella, Emilia; Iribarne, Alexander; Acker, Michael; Mack, Michael; Mathew, Joseph; O'Gara, Patrick; Gelijns, Annetine C; Suarez-Farinas, Mayte; Messé, Steven R; Cardiothoracic Surgical Trials Network (CTSN) Investigators
    AbstractObjectiveAlthough acute brain infarcts are common after surgical aortic valve replacement (SAVR), they are often unassociated with clinical stroke symptoms. The relationship between clinically “silent” infarcts and in‐hospital delirium remains uncertain; obscured, in part, by how infarcts have been traditionally summarized as global metrics, independent of location or structural consequence. We sought to determine if infarct location and related structural connectivity changes were associated with postoperative delirium after SAVR.MethodsA secondary analysis of a randomized multicenter SAVR trial of embolic protection devices (NCT02389894) was conducted, excluding participants with clinical stroke or incomplete neuroimaging (N = 298; 39% female, 7% non‐White, 74 ± 7 years). Delirium during in‐hospital recovery was serially screened using the Confusion Assessment Method. Parcellation and tractography atlas‐based neuroimaging methods were used to determine infarct locations and cortical connectivity effects. Mixed‐effect, zero‐inflated gaussian modeling analyses, accounting for brain region‐specific infarct characteristics, were conducted to examine for differences within and between groups by delirium status and perioperative neuroprotection device strategy.Results23.5% participants experienced postoperative delirium. Delirium was associated with significantly increased lesion volumes in the right cerebellum and temporal lobe white matter, while diffusion weighted imaging infarct‐related structural disconnection (DWI‐ISD) was observed in frontal and temporal lobe regions (p‐FDR < 0.05). Fewer brain regions demonstrated DWI‐ISD loss in the suction‐based neuroprotection device group, relative to filtration‐based device or standard aortic cannula.InterpretationStructural disconnection from acute infarcts was greater in patients who experienced postoperative delirium, suggesting that the impact from covert perioperative infarcts may not be as clinically “silent” as commonly assumed.
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    Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.
    (Journal of the American College of Cardiology, 2021-02) Bertrand, Philippe B; Overbey, Jessica R; Zeng, Xin; Levine, Robert A; Ailawadi, Gorav; Acker, Michael A; Smith, Peter K; Thourani, Vinod H; Bagiella, Emilia; Miller, Marissa A; Gupta, Lopa; Mack, Michael J; Gillinov, A Marc; Giustino, Gennaro; Moskowitz, Alan J; Gelijns, Annetine C; Bowdish, Michael E; O'Gara, Patrick T; Gammie, James S; Hung, Judy; Cardiothoracic Surgical Trials Network (CTSN)

    Background

    Whether to repair nonsevere tricuspid regurgitation (TR) during surgery for ischemic mitral valve regurgitation (IMR) remains uncertain.

    Objectives

    The goal of this study was to investigate the incidence, predictors, and clinical significance of TR progression and presence of ≥moderate TR after IMR surgery.

    Methods

    Patients (n = 492) with untreated nonsevere TR within 2 prospectively randomized IMR trials were included. Key outcomes were TR progression (either progression by ≥2 grades, surgery for TR, or severe TR at 2 years) and presence of ≥moderate TR at 2 years.

    Results

    Patients' mean age was 66 ± 10 years (67% male), and TR distribution was 60% ≤trace, 31% mild, and 9% moderate. Among 2-year survivors, TR progression occurred in 20 (6%) of 325 patients. Baseline tricuspid annular diameter (TAD) was not predictive of TR progression. At 2 years, 37 (11%) of 323 patients had ≥moderate TR. Baseline TR grade, indexed TAD, and surgical ablation for atrial fibrillation were independent predictors of ≥moderate TR. However, TAD alone had poor discrimination (area under the curve, ≤0.65). Presence of ≥moderate TR at 2 years was higher in patients with MR recurrence (20% vs. 9%; p = 0.02) and a permanent pacemaker/defibrillator (19% vs. 9%; p = 0.01). Clinical event rates (composite of ≥1 New York Heart Association functional class increase, heart failure hospitalization, mitral valve surgery, and stroke) were higher in patients with TR progression (55% vs. 23%; p = 0.003) and ≥moderate TR at 2 years (38% vs. 22%; p = 0.04).

    Conclusions

    After IMR surgery, progression of unrepaired nonsevere TR is uncommon. Baseline TAD is not predictive of TR progression and is poorly discriminative of ≥moderate TR at 2 years. TR progression and presence of ≥moderate TR are associated with clinical events. (Comparing the Effectiveness of a Mitral Valve Repair Procedure in Combination With Coronary Artery Bypass Grafting [CABG] Versus CABG Alone in People With Moderate Ischemic Mitral Regurgitation, NCT00806988; Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation, NCT00807040).
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    ItemOpen Access
    The Changing Economics of Pharmaceutical Research and Development
    (The Changing Economics of Medical Technology, 1991-01-01) Grabowski, HG