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1.
Thorac Cardiovasc Surg ; 70(4): 278-288, 2022 06.
Article in English | MEDLINE | ID: covidwho-1830277

ABSTRACT

PubMed displayed more than 35,000 hits for the search term "cardiac surgery AND 2021." We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term "myocardial revascularization" is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.


Subject(s)
Cardiac Surgical Procedures , Aged , Aortic Valve Stenosis/surgery , COVID-19 , Coronary Artery Disease/surgery , Fractional Flow Reserve, Myocardial , Humans , Percutaneous Coronary Intervention , Transcatheter Aortic Valve Replacement , Treatment Outcome
2.
Ann Cardiol Angeiol (Paris) ; 70(6): 435-445, 2021 Dec.
Article in French | MEDLINE | ID: covidwho-1540362

ABSTRACT

Developed in the late 1980s, rotational atherectomy has raised a lot of hope for its innovative principle of selective ablation, allowing volume reduction (instead of redistribution) of atherosclerotic plaque, while sparing healthy tissue. Long shunned for its disappointing results on restenosis, the Rotablator finally reasserted itself in the 2000s; era of drug eluting stents and coronary angioplasty boom, thus generating emergence of complex lesions. Indeed, the Rotablator has demonstrated an undeniable benefit in complex (type C) and calcified lesions preparation (before stenting), with a procedural success rate of 95%. Although these lesions only represent a small amount (2-3%) of percutaneous coronary interventions (PCI), they remain a technical impasse for plain-old balloon angioplasty strategy, making the Rotablator more suitable for these resistant lesions' treatment. Registry data attest the safety of this therapy, with a rate of peri-procedural complications and in-hospital mortality comparable to conventional angioplasty (France PCI register). However, certain specific, rare but serious complications (burr entrapment, broken Rotawire, coronary perforation) justify trained teams, perfect knowledge of the equipment, and strict compliance with good practice guidelines. In 2018, the rise of a new method of atherectomy by intra-vascular lithotripsy (Shockwave) has coincided with Rotablator decreasing activity (this finding being biased by a general decrease in PCI activity due to Covid pandemic). This therapeutic range's enhancement revolutionizes calcified lesions treatment, tending towards precise targeting of each indication, depending in particular on calcium distribution's anatomy in the plaque.


Subject(s)
Atherectomy, Coronary , COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Coronary Angiography , Coronary Artery Disease/surgery , Humans , Registries , SARS-CoV-2 , Treatment Outcome
3.
Indian Heart J ; 73(5): 549-554, 2021.
Article in English | MEDLINE | ID: covidwho-1370530

ABSTRACT

OBJECTIVE: Robotically assisted PCI offers a great alternative to S-PCI. This has gained even more relevance during the COVID-19 pandemic era however safety of R-PCI compared to S-PCI has not been studied well. This study explores the safety and efficacy of robotically assisted PCI (R-PCI) compared to standard PCI (S-PCI) for the treatment of coronary artery disease (CAD). METHODS: PubMed, Scopus, Ovid, and Google scholar databases were searched for studies comparing R-PCI to S-PCI. Outcomes included clinical success, procedure time, fluoroscopy time, contrast use and radiation exposure. RESULTS: Theauthors included 5 studies comprising 1555 patients in this meta-analysis. Clinical success was comparable in both arms (p = 0.91). Procedure time was significantly longer in R-PCI group (risk ratio: 5.52, 95% confidence interval: 1.85 to 9.91, p = 0.003). Compared to S-PCI, patients in R-PCI group had lower contrast use (meandifference: -19.88, 95% confidence interval: -21.43 to -18.33, p < 0.001), fluoroscopy time (mean difference:-1.82, 95% confidence interval: -3.64 to -0.00, p = 0.05) and radiation exposure (mean difference:-457.8, 95% confidence interval: -707.14 to -208.14, p < 0.001). CONCLUSION: R-PCI can achieve similar success as S-PCI at the expense of longer procedural times. However, radiation exposure and contrast exposure were lower in the R-PCI arm.


Subject(s)
COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Robotic Surgical Procedures , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Feasibility Studies , Humans , Pandemics , SARS-CoV-2 , Treatment Outcome
4.
J Cardiol ; 79(4): 455-459, 2022 04.
Article in English | MEDLINE | ID: covidwho-1364267

ABSTRACT

Coronavirus disease-2019 (COVID-19) has a profound impact on the health care system worldwide. In the COVID-19 pandemic, hospitals are required to halt elective surgeries and procedures for preventing nosocomial infections and saving medical resources. In these situations, emergency procedures are required for life-threatening cardiovascular diseases such as acute coronary syndrome and cardiogenic shock. To prevent the spread of COVID-19, a social distance is essentially required. In ordinary percutaneous coronary intervention (PCI), operators manipulate the devices standing at the patient's tableside during the whole procedure, which may involve a certain risk of exposure to patients with COVID-19. A robotic-assisted PCI (R-PCI) allows operators to manipulate devices remotely, sitting at a cockpit located several meters away from the patient, and in addition, the assistant can be at the foot of the bed, much further from the access site. R-PCI can help to minimize the radiation exposure and the amount of person-to-person contact, and consequently may reduce the risk for the exposure to the virus.


Subject(s)
COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Robotic Surgical Procedures , Coronary Angiography , Coronary Artery Disease/surgery , Humans , Pandemics , Percutaneous Coronary Intervention/adverse effects , SARS-CoV-2 , Treatment Outcome
5.
Ann Vasc Surg ; 73: 557-560, 2021 May.
Article in English | MEDLINE | ID: covidwho-1312937

ABSTRACT

Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Coronary Artery Bypass , Coronary Artery Disease/surgery , Leriche Syndrome/surgery , Saphenous Vein/transplantation , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , COVID-19/complications , COVID-19/diagnosis , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Fatal Outcome , Humans , Leriche Syndrome/complications , Leriche Syndrome/diagnostic imaging , Male , Middle Aged , Polyethylene Terephthalates , Treatment Outcome
6.
Am Heart J ; 241: 14-25, 2021 11.
Article in English | MEDLINE | ID: covidwho-1283847

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations. METHODS: Cardiovascular procedures performed at 30 hospitals across 6 Western states in 2 large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression. RESULTS: Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in 2 distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15-April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (P = .0003), older (P < .0001), Asian or Black (P = .02), or Medicare insured (P < .0001), and COVID I procedures were higher acuity (P < .0001), but not higher complexity. In COVID II, there was a trend toward more procedural deferral in regions with a higher COVID-19 burden (P = .05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases. CONCLUSIONS: Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.


Subject(s)
Aortic Valve Disease/surgery , COVID-19/epidemiology , Coronary Artery Bypass/statistics & numerical data , Coronary Artery Disease/surgery , Hospital Mortality , Percutaneous Coronary Intervention/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Transcatheter Aortic Valve Replacement/statistics & numerical data , African Americans , Aged , Asian Americans , Female , Heart Valve Prosthesis Implantation/statistics & numerical data , Humans , Logistic Models , Male , Medicare , Middle Aged , SARS-CoV-2 , Sex Factors , United States/epidemiology
7.
Clin Res Cardiol ; 110(9): 1525-1530, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1279447

ABSTRACT

Remote proctoring by advanced digital technologies may help to overcome pandemic, geographic, and resource-related constraints for mentoring and educating interventional cardiology skills. We present a case series of patients undergoing high-risk percutaneous coronary intervention (HR-PCI) with mechanical circulatory support (MCS) guided by remote proctoring to gain insights into a streaming technology platform with regard to video/audio quality, visibility of all structural and imaging details, and delay in transmission. According to our experience, remote proctoring appears to be a reliable, quick, and resource-conserving way to disseminate, educate and improve MCS-supported HR-PCI with implications far beyond the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Coronary Artery Disease/surgery , Intra-Aortic Balloon Pumping , Percutaneous Coronary Intervention , Remote Consultation , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/transmission , Cohort Studies , Humans , Male
8.
Catheter Cardiovasc Interv ; 99(2): 305-313, 2022 02.
Article in English | MEDLINE | ID: covidwho-1212727

ABSTRACT

OBJECTIVES: To describe outcomes following percutaneous coronary intervention (PCI) in patients who would usually have undergone coronary artery bypass grafting (CABG). BACKGROUND: In the United Kingdom, cardiac surgery for coronary artery disease (CAD) was dramatically reduced during the first wave of the COVID-19 pandemic. Many patients with "surgical disease" instead underwent PCI. METHODS: Between 1 March 2020 and 31 July 2020, 215 patients with recognized "surgical" CAD who underwent PCI were enrolled in the prospective UK-ReVasc Registry (ReVR). 30-day major cardiovascular event outcomes were collected. Findings in ReVR patients were directly compared to reference PCI and isolated CABG pre-COVID-19 data from British Cardiovascular Intervention Society (BCIS) and National Cardiac Audit Programme (NCAP) databases. RESULTS: ReVR patients had higher incidence of diabetes (34.4% vs 26.4%, P = .008), multi-vessel disease with left main stem disease (51.4% vs 3.0%, P < .001) and left anterior descending artery involvement (94.8% vs 67.2%, P < .001) compared to BCIS data. SYNTAX Score in ReVR was high (mean 28.0). Increased use of transradial access (93.3% vs 88.6%, P = .03), intracoronary imaging (43.6% vs 14.4%, P < .001) and calcium modification (23.6% vs 3.5%, P < .001) was observed. No difference in in-hospital mortality was demonstrated compared to PCI and CABG data (ReVR 1.4% vs BCIS 0.7%, P = .19; vs NCAP 1.0%, P = .48). Inpatient stay was half compared to CABG (3.0 vs 6.0 days). Low-event rates in ReVR were maintained to 30-day follow-up. CONCLUSIONS: PCI undertaken using contemporary techniques produces excellent short-term results in patients who would be otherwise CABG candidates. Longer-term follow-up is essential to determine whether these outcomes are maintained over time.


Subject(s)
COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Coronary Artery Bypass , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Hirudins , Humans , Pandemics , Prospective Studies , Recombinant Proteins , Registries , SARS-CoV-2 , Treatment Outcome
9.
Catheter Cardiovasc Interv ; 98(7): 1252-1261, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1148799

ABSTRACT

BACKGROUND: There are limited data on the impact of the COVID-19 pandemic on left main (LM) coronary revascularisation activity, choice of revascularisation strategy, and post-procedural outcomes. METHODS: All patients with LM disease (≥50% stenosis) undergoing coronary revascularisation in England between January 1, 2017 and August 19, 2020 were included (n = 22,235), stratified by time-period (pre-COVID: 01/01/2017-29/2/2020; COVID: 1/3/2020-19/8/2020) and revascularisation strategy (percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). Logistic regression models were performed to examine odds ratio (OR) of 1) receipt of CABG (vs. PCI) and 2) in-hospital and 30-day postprocedural mortality, in the COVID-19 period (vs. pre-COVID). RESULTS: There was a decline of 1,354 LM revascularisation procedures between March 1, 2020 and July 31, 2020 compared with previous years' (2017-2019) averages (-48.8%). An increased utilization of PCI over CABG was observed in the COVID period (receipt of CABG vs. PCI: OR 0.46 [0.39, 0.53] compared with 2017), consistent across all age groups. No difference in adjusted in-hospital or 30-day mortality was observed between pre-COVID and COVID periods for both PCI (odds ratio (OR): 0.72 [0.51. 1.02] and 0.83 [0.62, 1.11], respectively) and CABG (OR 0.98 [0.45, 2.14] and 1.51 [0.77, 2.98], respectively) groups. CONCLUSION: LM revascularisation activity has significantly declined during the COVID period, with a shift towards PCI as the preferred strategy. Postprocedural mortality within each revascularisation group was similar in the pre-COVID and COVID periods, reflecting maintenance in quality of outcomes during the pandemic. Future measures are required to safely restore LM revascularisation activity to pre-COVID levels.


Subject(s)
COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Humans , Pandemics , Percutaneous Coronary Intervention/adverse effects , SARS-CoV-2 , Treatment Outcome
10.
Eur J Heart Fail ; 22(12): 2248-2257, 2020 12.
Article in English | MEDLINE | ID: covidwho-1070736

ABSTRACT

AIMS: Coronavirus disease 2019 (COVID-19) is a widespread pandemic with an increased morbidity and mortality, especially for patients with cardiovascular diseases. Angiotensin-converting enzyme 2 (ACE2) has been identified as necessary cell entry point for SARS-CoV-2. Previous animal studies have demonstrated an increased ACE2 expression following treatment with either angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) that have led to a massive precariousness regarding the optimal cardiovascular therapy during this pandemic. METHODS AND RESULTS: We have measured ACE2 mRNA expression using real-time quantitative polymerase chain reaction in atrial biopsies of 81 patients undergoing coronary artery bypass grafting and we compared 62 patients that received ACEi/ARB vs. 19 patients that were not ACEi/ARB-treated. We found atrial ACE2 mRNA expression to be significantly increased in patients treated with an ACEi or an ARB, independent of potential confounding comorbidities. Interestingly, the cardiac ACE2 mRNA expression correlated significantly with the expression in white blood cells of 22 patients encouraging further evaluation if the latter may be used as a surrogate for the former. Similarly, analysis of 18 ventricular biopsies revealed a significant and independent increase in ACE2 mRNA expression in patients with end-stage heart failure that were treated with ACEi/ARB. On the other hand, cardiac unloading with a left ventricular assist device significantly reduced ventricular ACE2 mRNA expression. CONCLUSION: Treatment with ACEi/ARB is independently associated with an increased myocardial ACE2 mRNA expression in patients with coronary artery disease and in patients with end-stage heart failure. Further trials are needed to test whether this association is deleterious for patients with COVID-19, or possibly protective. Nevertheless, haemodynamic factors seem to be equally important for regulation of cardiac ACE2 mRNA expression.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme 2/genetics , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 , Leukocytes/metabolism , Myocardium/metabolism , RNA, Messenger/metabolism , Receptors, Coronavirus/genetics , Aged , Coronary Artery Bypass , Coronary Artery Disease/surgery , Female , Heart Failure/therapy , Heart-Assist Devices , Hemodynamics , Humans , Male , Middle Aged , SARS-CoV-2
13.
Can J Cardiol ; 37(6): 887-894, 2021 06.
Article in English | MEDLINE | ID: covidwho-898623

ABSTRACT

BACKGROUND: Left main coronary arterial (LMCA) atresia is a rare coronary arterial anomaly with extremely limited data on the optimal management. We aimed to report our single-surgeon experience of the ostioplasty in patients with LMCA atresia. METHODS: From July 2018 to December 2019, pediatric patients who presented with LMCA atresia and subsequently underwent surgical coronary ostioplasty were recruited into this retrospective study. Concomitant mitral repair was applied when the regurgitation was moderate or more severe. RESULTS: A total of 9 patients diagnosed with LMCA atresia were included. Mitral regurgitation was found in all of them, including 6 (66.7%) severe, 1 (11.1%) moderate, and 2 (22.2%) mild. In addition to ischemic lesions, which were found in 7 (77.8%) patients, structural mitral problems were also common (presented in 7 [77.8%] patients). All the patients underwent coronary ostioplasty with autologous pulmonary arterial patch augmenting the anterior wall of the neo-ostium. Mean aortic cross clamp time and cardiopulmonary bypass time was 88.1 ± 18.9 and 124.6 ± 23.6 minutes, respectively. During a median of 10.9 (range: 3.3 to 17.2) months' follow-up, there was only 1 death at 5 months after surgery. All survivors were recovered uneventfully with normal left-ventricular function; however, with 4 (50.0%) having significant recurrence of mitral regurgitation. CONCLUSIONS: With favourable surgical outcomes, coronary ostioplasty for LMCA atresia may be an option of revascularization. Structural mitral problems presented in majority patients, resulting in the requirement of concomitant mitral repair. However, the optimal technique of mitral repair remains unclear.


Subject(s)
Angioplasty/methods , Coronary Artery Disease , Coronary Vessel Anomalies , Mitral Valve Annuloplasty , Mitral Valve Insufficiency , Pulmonary Artery/transplantation , Aorta, Thoracic/surgery , Child, Preschool , Coronary Angiography/methods , Coronary Artery Disease/complications , Coronary Artery Disease/congenital , Coronary Artery Disease/surgery , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Female , Humans , Male , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Annuloplasty/methods , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Myocardial Revascularization/methods , Operative Time , Recurrence , Transplantation, Autologous/methods , Treatment Outcome
16.
J Card Surg ; 35(9): 2361-2363, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-640368

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is overwhelming healthcare resources and infrastructure worldwide. Earlier reports have demonstrated complicated postoperative courses and high fatality rates in patients undergoing emergent cardiothoracic surgery who were diagnosed postoperatively with COVID-19. These reports raise the possibility that active COVID-19 might precipitate a catastrophic pathophysiological response to infection in the postoperative period and lead to unfavorable surgical outcomes. Hence, it is imperative to screen patients with SARS-CoV-2 infection before surgery and to carefully monitor them in the postoperative period to identify any signs of active COVID-19. In this report, we present the successful outcome of coronary artery bypass grafting (CABG) operation in a patient with asymptomatic SARS-CoV-2 infection presenting with an acute coronary syndrome and requiring urgent surgical intervention. We employed a thorough strategy to identify subclinical COVID-19 disease, and after confirming the absence of active disease, proceeded with the CABG operation. The patient outcome was successful with the absence of any overt COVID-19 manifestations in the postoperative period.


Subject(s)
Acute Coronary Syndrome/surgery , COVID-19/complications , Coronary Artery Bypass , Acute Coronary Syndrome/diagnosis , Aged , COVID-19/diagnosis , Cardiac Catheterization , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Coronary Occlusion/diagnosis , Coronary Occlusion/surgery , Female , Humans , Lung/diagnostic imaging , Non-ST Elevated Myocardial Infarction/surgery , Pleural Effusion/diagnostic imaging , Tomography, X-Ray Computed
18.
Ann Thorac Surg ; 110(5): e449-e450, 2020 11.
Article in English | MEDLINE | ID: covidwho-506081

ABSTRACT

The COVID-19 pandemic has necessitated that operating room procedures be modified to ensure the safety of staff and patients. Specifically, procedures that have the potential to create aerosolization must be reassessed, given the risk of viral transmission via aerosolization. We present the use of a nonsealed endoscopic vessel harvesting approach during coronary surgery that does not necessitate the use of CO2 insufflation and utilizes suction through an ultra low particulate filter, thus mitigating the risk of possible viral transmission via aerosolization or surgical smoke production. This approach is technically feasible and can minimize the risk of viral transmission during endoscopic vessel harvesting.


Subject(s)
Betacoronavirus , Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Coronavirus Infections/epidemiology , Endoscopy/methods , Pneumonia, Viral/epidemiology , Saphenous Vein/transplantation , Tissue and Organ Harvesting/methods , Aged , COVID-19 , Comorbidity , Coronary Artery Disease/epidemiology , Female , Humans , Male , Pandemics , SARS-CoV-2
19.
Am Heart J ; 224: 148-155, 2020 06.
Article in English | MEDLINE | ID: covidwho-276755

ABSTRACT

BACKGROUND: Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals' cost advantages to US peers remains unclear. METHODS: Using time-driven activity-based costing methods, we estimate the average cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two American hospitals and one Indian hospital (NH). All three hospitals are Joint Commission accredited and have reputations for use of modern performance management methods. Our case study applies several analytic steps to distinguish transferable from non-transferable sources of NH's cost savings. RESULTS: After removing non-transferable sources of efficiency, NH's residual cost advantage primarily rests on shifting tasks to less-credentialed and/or less-experienced personnel who are supervised by highly-skilled personnel when perceived risk of complications is low. NH's high annual CABG volume facilitates such supervised work "downshifting." The study is subject to limitations inherent in case studies, does not account for the younger age of NH's patients, or capture savings attributable to NH's negligible frequency of re-admission or post-acute care facility placement. CONCLUSIONS: Most transferable bases for a modern Indian hospital's cost advantage would require more flexible American states' hospital and health professional licensing regulations, greater family participation in inpatient care, and stronger support by hospital executives and clinicians for substantially lowering the cost of care via regionalization of complex surgeries and weekend use of costly operating rooms.


Subject(s)
Coronary Artery Bypass/economics , Coronary Artery Disease/surgery , Elective Surgical Procedures/economics , Hospital Costs , Medicare/economics , Patient Transfer/economics , Coronary Artery Disease/economics , Female , Humans , India , Male , United States
20.
Heart Surg Forum ; 23(2): E231-E233, 2020 04 21.
Article in English | MEDLINE | ID: covidwho-182809

ABSTRACT

While the focus of the medical community is on the management of COVID-19 and its associated complex presentations, it is critical to recognize that patients will continue to present with other medical problems that require urgent therapeutic interventions. There is growing concern that such interventions might have an impact on the natural history of COVID-19. We present a case of a patient who presented with unstable angina and multivessel coronary artery disease for which coronary artery bypass surgery was indicated and performed. Unfortunately, he succumbed to respiratory complications attributed to COVID-19. Our experience suggests concern about adverse outcomes in patients undergoing cardiac surgery who might be infected with COVID-19. Clearly, additional investigations and experience are needed.


Subject(s)
Angina, Unstable/surgery , Coronary Artery Bypass , Coronary Artery Disease/surgery , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Postoperative Complications , Betacoronavirus , COVID-19 , Coronary Artery Bypass/adverse effects , Coronavirus Infections/complications , Humans , Male , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , Treatment Outcome
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