The Canadian journal of cardiology
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Multicenter Study
Sutureless aortic valve replacement: a Canadian multicentre study.
Sutureless aortic valve replacement (AVR) has recently been introduced as an alternative to standard AVR in elderly high-risk surgical patients. The purpose of this study was to report the early Canadian experience with sutureless AVR. ⋯ Sutureless AVR using the Perceval S prosthesis is safe and reproducible and results in short operative times. Echocardiographic results are encouraging, with low gradients and no paravalvular aortic insufficiency. However, in this series, sutureless AVR was associated with a high risk of permanent pacemaker implantation.
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Multicenter Study
Atrial fibrillation patients categorized as "not for anticoagulation" according to the 2014 Canadian Cardiovascular Society algorithm are not "low risk".
Oral anticoagulation (OAC) is highly effective for stroke prevention in nonvalvular atrial fibrillation. We explored rates of stroke/thromboembolism/transient ischemic attack among the "OAC not recommended" patient group defined according to the 2014 Canadian Cardiovascular Society (CCS) algorithm (based on the Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack [CHADS2] score) who would have been offered OAC using the European Society of Cardiology (ESC) guidelines approach (based on the Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]; CHA2DS2-VASc score). ⋯ Based on the 2014 CCS algorithm, the "OAC not recommended" subgroup can have a high 1-year stroke rate overall, showing that such patients are not "low risk." Use of the ESC guideline approach (based on the CHA2DS2-VASc) offers refinement of stroke risk stratification in such patients.
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Multicenter Study Comparative Study
Managing novel oral anticoagulants in patients with atrial fibrillation undergoing device surgery: Canadian survey.
Approximately 10% of patients who undergo surgical procedures require chronic oral anticoagulation. Physicians must balance the thromboembolic and bleeding risks to make informed decisions on whether to continue anticoagulant medication. Evidence is lacking regarding the perioperative management of novel oral anticoagulant (NOAC) agents. This survey aims to describe the management of perioperative NOAC use during device implantation by Canadian centres. ⋯ Most Canadian centres perform device implantation with NOAC interruption without the use of bridging. The timing of stopping and restarting anticoagulation and incidence of bleeding complications is variable. These findings emphasize the need for randomized controlled studies to guide the optimal approach to management of NOACs during device implantation.
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Multicenter Study
Defibrillation success is not associated with near field electrogram complexity or shock timing.
It has been suggested that more-complex fibrillation requires higher energy shocks to terminate. Furthermore, animal studies have demonstrated that shock timing also plays a role. The objective of this study was to test these assertions in a clinical context. ⋯ Signal organization of a local electrogram and phase of shock delivery do not relate to minimum defibrillation shock energy immediately after ventricular fibrillation onset.
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Multicenter Study Comparative Study
Does preoperative atrial fibrillation portend a poorer prognosis in patients undergoing isolated aortic valve replacement? A multicentre Australian study.
Preoperative atrial fibrillation (preop-AF) has been associated with poorer early and late outcomes after cardiac surgery. Few studies, however, have evaluated the impact of preop-AF on early and late outcomes after isolated aortic valve replacement (AVR). ⋯ Preop-AF is associated with an increased risk of late mortality after isolated AVR. As such, concomitant atrial ablation with AVR should be prospectively studied.