Robert Saeid Farivar

Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

This study examined the impact of integrated intensivist consultation in the immediate postoperative period on outcomes for cardiac surgery patients. A retrospective cohort study was conducted in 1711 adult cardiac surgery patients from a single quaternary care center in Minnesota. Outcomes were compared across 2 consecutive 2-year time periods reflecting an elective intensivist model (n = 801) and an integrated intensivist model (n = 910). Patients under the 2 models were comparable with respect to demographics, comorbidities, procedure types, and Society for Thoracic Surgery predicted risk of mortality score; however, patients in the earlier cohort were slightly older and more likely to have chronic kidney disease (P = .003). Integrated intensivist involvement was associated with reduced postoperative ventilator time, length of stay (LOS), stroke, encephalopathy, and reoperations for bleeding (all P < .01) but was not associated with mortality. Intensivist integration into the postoperative care of cardiac surgery patients may reduce ventilator time, LOS, and complications but may not improve survival.

Current Status of Catheter-Based Treatment of Mitral Valve Regurgitation

Purpose of ReviewThis review examines the current status of catheter-based repair and replacement for mitral valve disease, with a focus on native primary and secondary mitral valve regurgitation.Recent FindingsTranscatheter mitral valve repair with the MitraClip®, with >40,000 performed procedures worldwide, has significantly advanced the field of transcatheter therapy for mitral valve regurgitation. Transcatheter mitral valve replacement remains in the early stages of development, mainly due to the complex anatomy and physiology of the mitral valve. Early feasibility studies in high-risk patients show promising procedural success, yet the adverse events require further study.SummaryTranscatheter therapies for mitral valve disease are the next endeavor for the pioneers of percutaneous structural heart disease interventions. Early results are encouraging but also show that further rigorous study is needed to determine efficacy and safety.

IMPACT OF THE COMMERCIAL INTRODUCTION OF TRANSCATHETER MITRAL VALVE REPAIR ON MITRAL SURGICAL PRACTICE

With the commercial introduction of transcatheter mitral valve repair with MitraClip into the U.S. in 2013, there has been uncertainty regarding the effect of this therapy on cardiac surgical practice. The present investigation was undertaken to examine the impact of this introduction in the context

SURGICAL RISK AND THERAPY OF SEVERE SYMPTOMATIC DEGENERATIVE MITRAL VALVE REGURGITATION IN THE CONTEMPORARY ERA

Background: Severe degenerative mitral valve regurgitation (DMR) carries an adverse prognosis, yet afflicted patients may not undergo treatment despite availability of contemporary therapy. We sought to examine the relationship between surgical risk, therapeutic penetrance, and survival for patients