17 results on '"Wood, DA"'
Search Results
2. Knowledge Translation and Systems Transformation Needed: Improving Timely and Equitable Access to Innovations in Heart Valve Disease.
- Author
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Lauck SB, Sheth T, Tang E, and Wood DA
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- Humans, Translational Science, Biomedical, Heart Valve Diseases
- Published
- 2024
- Full Text
- View/download PDF
3. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive.
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Guerra PG, Simpson CS, Van Spall HGC, Asgar AW, Billia P, Cadrin-Tourigny J, Chakrabarti S, Cheung CC, Dore A, Fordyce CB, Gouda P, Hassan A, Krahn A, Luc JGY, Mak S, McMurtry S, Norris C, Philippon F, Sapp J, Sheldon R, Silversides C, Steinberg C, and Wood DA
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- Humans, Arrhythmias, Cardiac therapy, Canada epidemiology, Observational Studies as Topic, Cardiovascular System, Coronary Artery Disease, Frontotemporal Dementia, Myocardial Ischemia
- Abstract
Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might induce unpredictable mental state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society previously published FTD guidelines in 2003-2004; herein, we present updated FTD guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of Canadian Cardiovascular Society Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers. We provide guidance for individuals with: (1) active coronary artery disease; (2) various forms of valvular heart disease; (3) heart failure, heart transplant, and left ventricular assist device situations; (4) arrhythmia syndromes; (5) implantable devices; (6) syncope history; and (7) congenital heart disease. We suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. When short-term driving cessation is recommended, recommendations are on the basis of expert consensus rather than the Risk of Harm formula because risk elevation is expected to be transient. These recommendations, although not a substitute for clinical judgement or governmental regulations, provide specialists, primary care providers, and allied health professionals with a comprehensive list of a wide range of cardiac conditions, with guidance provided on the basis of the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions., (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
4. Valve-in-Valve Transcatheter Mitral Valve Replacement: A Large First-in-Human 13-Year Experience.
- Author
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Akodad M, Trpkov C, Cheung A, Ye J, Chatfield AG, Alosail A, Besola L, Yu M, Leipsic JA, Lounes Y, Meier D, Yang C, Nestelberger T, Tzimas G, Sathananthan J, Wood DA, Moss RR, Blanke P, Sathananthan G, and Webb JG
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- Humans, Female, Aged, Aged, 80 and over, Male, Mitral Valve diagnostic imaging, Mitral Valve surgery, Treatment Outcome, Cardiac Catheterization adverse effects, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency etiology
- Abstract
Background: Favourable early outcomes have been reported following valve-in-valve transcatheter mitral valve replacement (TMVR). However, reports of long-term outcomes are lacking. We aimed to evaluate early and late outcomes in a large first-in-human valve-in-valve TMVR 13-year experience., Methods: All patients undergoing valve-in-valve TMVR in our centre from 2008 to 2021 were included. Clinical and echocardiographic outcomes, defined according to the Mitral Valve Academic Research Consortium, were reported., Results: A total of 119 patients were analysed: mean age 76.8 ± 10.2 years, mean Society of Thoracic Surgeons score 10.7 ± 6.8%, 55.4% female, 63.9% transapical access. Thirty-day mortality was 2.5% for the total population and 0.0% after transseptal TMVR. Maximum follow-up was 13.1 years. During a median follow-up of 3.4 years (interquartile range 1.8-5.3 years), 55 patients (46.2%) died, mainly from noncardiovascular causes. Valve hemodynamics were acceptable at 5 years, with 2.5% structural dysfunction. Patients treated from 2016 on (n = 68; 57.1%), following the advent of routine use of the Sapien 3 valve, CT screening, and transseptal access, were compared with those treated before 2016 (n = 51; 42.9%). Patients from 2016 on had a higher technical success rate (100.0% vs 94.1%; P = 0.04), shorter hospitalisation (P < 0.001), trending lower 30-day mortality (1.5% vs 3.9%; P = 0.4) and better 5-year survival (74.7% vs 41.1%; P = 0.03)., Conclusions: Valve-in-valve TMVR can be performed with little morbidity and low mortality. Mid- to long-term survival remains limited owing to advanced age and comorbidities. Structural bioprosthetic valve dysfunction was rare and redo TMVR feasible in selected patients. Outcomes continue to improve, but the role for valve-in-valve TMVR in lower surgical risk patients remains unclear., (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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5. A National Strategy to Detect and Treat Heart Valve Diseases in Canada.
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Forcillo J, Wood DA, Abdel-Razek O, Adreak N, Asgar A, Chedrawy E, Eckstein J, Legare JF, Natarajan MK, Pibarot P, Styra R, Tyrrell B, Wijeysundera H, and Messika-Zeitoun D
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- Humans, Canada epidemiology, Aortic Valve surgery, Treatment Outcome, Heart Valve Diseases diagnosis, Heart Valve Diseases epidemiology, Heart Valve Diseases therapy, Heart Valve Prosthesis Implantation, Heart Valve Prosthesis
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- 2023
- Full Text
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6. Cardiovascular Care Delivery During the Second Wave of COVID-19 in Canada.
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Roifman I, Arora RC, Bewick D, Chow CM, Clarke B, Cowan S, Ducharme A, Gin K, Graham M, Gupta A, Hardiman S, Hartleib M, Jackson S, Jassal D, Kazmi M, Lamarche Y, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Ruel M, Small G, Sterns L, Turgeon R, Virani S, Wijeysundera HC, Wong K, Wood DA, Zieroth S, Singh G, and Krahn AD
- Subjects
- Canada epidemiology, Cardiovascular Diseases epidemiology, Comorbidity, Humans, COVID-19 epidemiology, Cardiovascular Diseases therapy, Critical Care methods, Delivery of Health Care organization & administration, Pandemics
- Abstract
Hospitals and ambulatory facilities significantly reduced cardiac care delivery in response to the first wave of the COVID-19 pandemic. The deferral of elective cardiovascular procedures led to a marked reduction in health care delivery with a significant impact on optimal cardiovascular care. International and Canadian data have reported dramatically increased wait times for diagnostic tests and cardiovascular procedures, as well as associated increased cardiovascular morbidity and mortality. In the wake of the demonstrated ability to rapidly create critical care and hospital ward capacity, we advocate a different approach during the second and possible subsequent COVID-19 pandemic waves. We suggest an approach, informed by local data and experience, that balances the need for an expected rise in demand for health care resources to ensure appropriate COVID-19 surge capacity with continued delivery of essential cardiovascular care. Incorporating cardiovascular care leaders into pandemic planning and operations will help health care systems minimise cardiac care delivery disruptions while maintaining critical care and hospital ward surge capacity and continuing measures to reduce transmission risk in health care settings. Specific recommendations targeting the main pillars of cardiovascular care are presented: ambulatory, inpatient, procedural, diagnostic, surgical, and rehabilitation., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
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7. Use of Renin-Angiotensin System Blockers During the COVID-19 Pandemic: Early Guidance and Evolving Evidence.
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Turgeon RD, Zieroth S, Bewick D, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lau B, Leong-Poi H, Mansour S, Marelli A, Quraishi AR, Roifman I, Ruel M, Sapp J, Singh G, Small G, Virani S, Wood DA, and Krahn A
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- Angiotensin-Converting Enzyme 2, COVID-19, Humans, Patient Care Management, Peptidyl-Dipeptidase A metabolism, Practice Guidelines as Topic, SARS-CoV-2, Virus Internalization drug effects, Angiotensin II Type 1 Receptor Blockers pharmacology, Angiotensin-Converting Enzyme Inhibitors pharmacology, Betacoronavirus physiology, Coronavirus Infections epidemiology, Coronavirus Infections therapy, Coronavirus Infections virology, Heart Failure drug therapy, Hypertension drug therapy, Pandemics, Pneumonia, Viral epidemiology, Pneumonia, Viral therapy, Pneumonia, Viral virology, Renin-Angiotensin System drug effects, Renin-Angiotensin System physiology
- Published
- 2020
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8. Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care.
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Moulson N, Bewick D, Selway T, Harris J, Suskin N, Oh P, Coutinho T, Singh G, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lamarche Y, Lau B, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Quraishi AUR, Roifman I, Ruel M, Sapp J, Small G, Turgeon R, Wood DA, Zieroth S, Virani S, and Krahn AD
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- Betacoronavirus, COVID-19, Canada, Humans, Infection Control organization & administration, Models, Organizational, Organizational Innovation, Risk Assessment, SARS-CoV-2, Cardiac Rehabilitation methods, Cardiac Rehabilitation trends, Cardiovascular Diseases epidemiology, Cardiovascular Diseases prevention & control, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Pandemics prevention & control, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control, Telerehabilitation methods, Telerehabilitation organization & administration
- Abstract
Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting. Centres should initially focus on the collation, utilization, and repurposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed before COVID-19, and to improve cardiac rehabilitation delivery, moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
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9. Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System Response.
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Virani A, Singh G, Bewick D, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lamarche Y, Lau B, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Quraishi A, Roifman I, Ruel M, John Sapp, Small G, Turgeon R, Wood DA, Zieroth S, Virani S, and Krahn AD
- Subjects
- Betacoronavirus isolation & purification, COVID-19, Canada epidemiology, Humans, Models, Organizational, Organizational Innovation, SARS-CoV-2, Cardiology Service, Hospital organization & administration, Cardiology Service, Hospital trends, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Ethics, Institutional, Infection Control methods, Pandemics prevention & control, Patient Care Management ethics, Patient Care Management methods, Patient Care Management standards, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control
- Abstract
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
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- 2020
- Full Text
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10. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership.
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Wood DA, Mahmud E, Thourani VH, Sathananthan J, Virani A, Poppas A, Harrington RA, Dearani JA, Swaminathan M, Russo AM, Blankstein R, Dorbala S, Carr J, Virani S, Gin K, Packard A, Dilsizian V, Légaré JF, Leipsic J, Webb JG, and Krahn AD
- Subjects
- COVID-19, Coronavirus Infections epidemiology, Electrophysiologic Techniques, Cardiac statistics & numerical data, Female, Health Services, Humans, Leadership, Male, North America, Occupational Health, Outcome Assessment, Health Care, Pandemics statistics & numerical data, Patient Safety, Pneumonia, Viral epidemiology, Societies, Medical organization & administration, Coronavirus Infections prevention & control, Electrophysiologic Techniques, Cardiac methods, Infectious Disease Transmission, Patient-to-Professional prevention & control, Pandemics prevention & control, Pneumonia, Viral prevention & control, Safety Management organization & administration
- Published
- 2020
- Full Text
- View/download PDF
11. Precautions and Procedures for Coronary and Structural Cardiac Interventions During the COVID-19 Pandemic: Guidance from Canadian Association of Interventional Cardiology.
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Wood DA, Sathananthan J, Gin K, Mansour S, Ly HQ, Quraishi AU, Lavoie A, Lutchmedial S, Nosair M, Bagai A, Bainey KR, Boone RH, Liu S, Krahn A, Virani S, Mehta SR, Natarajan MK, Velianou JL, Dehghani P, Wijeysundera HC, Asgar AW, Virani A, Welsh RC, Webb JG, and Cohen EA
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- Humans, Canada, COVID-19, Risk Management, Cardiology methods, Cardiology standards, Cardiology trends, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Heart Diseases therapy, Pandemics legislation & jurisprudence, Pandemics prevention & control, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control
- Abstract
The globe is currently in the midst of a COVID-19 pandemic, resulting in significant morbidity and mortality. This pandemic has placed considerable stress on health care resources and providers. This document from the Canadian Association of Interventional Cardiology- Association Canadienne de Cardiologie d'intervention, specifically addresses the implications for the care of patients in the cardiac catheterization laboratory (CCL) in Canada during the COVID-19 pandemic. The key principles of this document are to maintain essential interventional cardiovascular care while minimizing risks of COVID-19 to patients and staff and maintaining the overall health care resources. As the COVID-19 pandemic evolves, procedures will be increased or reduced based on the current level of restriction to health care services. Although some consistency across the country is desirable, provincial and regional considerations will influence how these recommendations are implemented. We believe the framework and recommendations in this document will provide crucial guidance for clinicians and policy makers on the management of coronary and structural procedures in the CCL as the COVID-19 pandemic escalates and eventually abates., (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
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- 2020
- Full Text
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12. Impact of Chronic Kidney Disease on Decision Making and Management in Transcatheter Aortic Valve Interventions.
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Hensey M, Murdoch DJ, Sathananthan J, Wood DA, and Webb JG
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- Aortic Valve Stenosis complications, Humans, Risk Factors, Aortic Valve surgery, Aortic Valve Stenosis surgery, Decision Making, Heart Valve Prosthesis, Practice Guidelines as Topic, Renal Insufficiency, Chronic complications, Transcatheter Aortic Valve Replacement methods
- Abstract
The coexistence of chronic kidney disease (CKD) and severe aortic stenosis (AS) is common, and the prevalence of both is rising. The 2 conditions are inherently linked in that significant CKD may accelerate the development of AS and severe AS may result in deteriorating kidney function. The volume of and indications for transcatheter aortic valve implantation (TAVI) procedures are ever-increasing, and there are many challenges that need to be considered in patients with concomitant severe AS and CKD being assessed for TAVI. Throughout the process of working these patients up for definitive management of their valvular heart disease, the presence of CKD impacts on diagnostic investigations, treatment decisions, and therapeutic interventions. Herein we review the current literature regarding TAVI in patients with CKD focusing on the decision-making process and specific risks involved in TAVI and CKD. We also provide specific practical strategies to best manage this challenging patient cohort., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
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13. 2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion.
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Wong GC, Welsford M, Ainsworth C, Abuzeid W, Fordyce CB, Greene J, Huynh T, Lambert L, Le May M, Lutchmedial S, Mehta SR, Natarajan M, Norris CM, Overgaard CB, Perry Arnesen M, Quraishi A, Tanguay JF, Traboulsi M, van Diepen S, Welsh R, Wood DA, and Cantor WJ
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- Canada, Humans, Cardiology, Disease Management, Percutaneous Coronary Intervention standards, Practice Guidelines as Topic, ST Elevation Myocardial Infarction surgery, Societies, Medical
- Abstract
Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre. We had also planned to evaluate and incorporate sex and gender considerations in the development of our recommendations. Unfortunately, inadequate enrollment of women in randomized trials, lack of publication of main outcomes stratified according to sex, and lack of inclusion of gender as a study variable in the available literature limited the feasibility of such an approach. The Grading Recommendations, Assessment, Development, and Evaluation system was used to develop specific evidence-based recommendations for the early identification of STEMI patients, practical aspects of patient transport, regional reperfusion decision-making, adjunctive prehospital interventions (oxygen, opioids, antiplatelet therapy), and procedural aspects of mechanical reperfusion (access site, thrombectomy, antithrombotic therapy, extent of revascularization). Emphasis is placed on integrating these recommendations as part of an organized regional network of STEMI care and the development of appropriate reperfusion and transportation pathways for any given region. It is anticipated that these guidelines will serve as a practical template to develop systems of care capable of providing optimal treatment for a wide range of STEMI patients., (Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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14. Reconfiguring Cardiac Rehabilitation to Achieve Panvascular Prevention: New Care Models for a New World.
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Sandesara PB, Dhindsa D, Khambhati J, Lee SK, Varghese T, O'Neal WT, Harzand A, Gaita D, Kotseva K, Connolly SB, Jennings C, Grace SL, Wood DA, and Sperling L
- Subjects
- Cardiovascular Agents therapeutic use, Global Health, Humans, Models, Organizational, Risk Factors, Risk Reduction Behavior, Survival Analysis, Cardiac Rehabilitation methods, Cardiovascular Diseases mortality, Cardiovascular Diseases prevention & control, Cardiovascular Diseases psychology, Delivery of Health Care, Integrated organization & administration, Quality of Life, Secondary Prevention methods
- Abstract
Atherosclerotic cardiovascular disease (ASCVD) and its associated economic burden are increasing globally. Although cardiac rehabilitation is a vital component of secondary prevention with proven benefits, it is underutilized due to numerous barriers, especially in resource-limited settings. New care models for delivery of comprehensive prevention programs such as community-based, home-based, and "hybrid" models implementing m-health, e-health, and telemedicine need to be adopted. Such new care models should be offered to all patients with established ASCVD (coronary, cerebral, and peripheral) and additionally to those at high risk of developing ASCVD with multiple risk factors for panvascular prevention., (Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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15. Adult Congenital Heart Disease Intervention: The Canadian Landscape.
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Frankfurter C, Asgar AW, Webb JG, Cantor WJ, Velianou JL, Gobeil F, Chan AW, Welsh RC, Love MP, Wood DA, McKenzie K, and Horlick EM
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- Adult, Canada epidemiology, Cardiac Catheterization methods, Cardiac Surgical Procedures methods, Cross-Sectional Studies, Heart Defects, Congenital epidemiology, Humans, Incidence, Cardiac Catheterization statistics & numerical data, Cardiac Surgical Procedures statistics & numerical data, Heart Defects, Congenital surgery, Surveys and Questionnaires
- Abstract
Once considered a childhood disease, the number of adults living with congenital heart disease (CHD) has now exceeded the number of pediatric patients. The landscape of percutaneous intervention for adult congenital heart disease (ACHD) has evolved over the past decade and has yet to be characterized in Canada. The aim of this study was to begin to understand the current infrastructure underlying ACHD interventions in Canada and to characterize the type and number of interventions being carried out across the country. A cross-sectional national survey was distributed by e-mail to all cardiac catheterization laboratory directors in 2015. All Canadian laboratories involved in ACHD interventions responded, encompassing 19 institutions spanning 69 cardiac catheterization laboratories. A total of 1451 percutaneous interventions were recorded. Nationwide, the most common simple ACHD interventions were for atrial septal defect and patent foramen ovale closures. The most common ACHD interventions of increased complexity were for coarctation stenting and transcatheter pulmonary valve implantation. There was a marked clustering of procedures in Ontario, Québec, British Columbia, and Alberta in keeping with Canada's population-density distribution. A total of 23 ACHD operators were identified, half of whom had ACHD-specific fellowship training. These data can be used as a starting point to inform the present state of affairs in the area and lay the groundwork for further work to assess resource allocation and human resource planning for the care of patients with ACHD in Canada., (Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
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16. Risk stratification and clinical pathways to optimize length of stay after transcatheter aortic valve replacement.
- Author
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Lauck SB, Wood DA, Achtem L, Baumbusch J, Boone RH, Cheung A, Dvir D, Stub D, Tan JS, Ye J, and Webb JG
- Subjects
- Aged, 80 and over, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, British Columbia epidemiology, Echocardiography, Transesophageal, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Kaplan-Meier Estimate, Male, Severity of Illness Index, Tomography, X-Ray Computed, Treatment Outcome, Aortic Valve Stenosis surgery, Cardiac Catheterization, Critical Pathways, Heart Valve Prosthesis, Length of Stay trends, Risk Assessment methods, Transcatheter Aortic Valve Replacement methods
- Abstract
Background: Transcatheter aortic valve replacement (TAVR) program experience and advances present opportunities to introduce minimalist clinical pathways. The purpose of this study was to determine the safety and feasibility of preprocedural individualized risk stratification for general anaesthesia and transesophageal echocardiography (GA/TEE) or awake TAVR and the postprocedural standard or rapid discharge TAVR clinical pathways., Methods: Standardized screening and multidisciplinary heart team consensus was used to evaluate individual periprocedural risk and requirements. Postprocedural clinical status and criteria guided the timing of discharge. We evaluated standardized TAVR outcomes and length of stay according to periprocedural practice and postprocedural trajectory., Results: In 144 consecutive patients who underwent TAVR in 2013 (mean age, 82.0 ± 7.1 years; 38.2% women; mean Society of Thoracic Surgeons score, 6.5% ± 4.1%), 101 (69.1%) were assigned to the GA/TEE protocol, whereas 43 (29.9%) were assigned to the minimalist awake TAVR protocol. Irrespective of mode of anaesthesia, 94 (65.3%) patients were discharged within the standard time, whereas 50 (34.7%) patients were suitable for rapid discharge. Overall outcomes at 30 days were 2.1% mortality, 1.4% stroke, and 2.1% life-threatening bleeding. Median length of stay was shortest in the awake TAVR group (2 days; interquartile range [IQR], 1-3 days) and rapid discharge group (2 days; IQR, 1-2 days) and longer in the GA/TEE and standard discharge (3 days, IQR, 3-4 days) groups., Conclusions: Excellent outcomes and decreased length of stay can be achieved with individualized risk stratification to select the optimal periprocedural practice and determine the timing of discharge. These findings should be further evaluated in a large long-term clinical study., (Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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17. Fame comes at a cost: a Canadian analysis of procedural costs in use of pressure wire to guide multivessel percutaneous coronary intervention.
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Hoole SP, Seddon MD, Poulter RS, Mancini GB, Wood DA, and Saw J
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- Angioplasty, Balloon, Coronary instrumentation, Canada, Coronary Angiography economics, Coronary Artery Disease diagnosis, Coronary Artery Disease economics, Costs and Cost Analysis, Equipment Design, Humans, Pressure, Angioplasty, Balloon, Coronary economics, Coronary Artery Disease therapy, Fractional Flow Reserve, Myocardial, Health Care Costs
- Abstract
The FAME-study authors claimed that fractional flow reserve (FFR)-guided multivessel percutaneous coronary intervention (PCI) achieved superior clinical outcome and lower cost compared with no FFR. However, patients were intended to undergo multivessel PCI with drug eluting stents prior to randomization, which tipped the cost-analysis heavily in favour of FFR. We retrospectively evaluated 100 intermediate coronary lesions assessed by FFR, and determined whether to perform PCI based on visual angiographic assessment alone. We found that angiographic-guided treatment underestimated functional significance of intermediate lesions, resulting in fewer implanted stents compared to FFR guidance. This, in addition to the pressure wire cost, increased procedural expenditure 2- to 3-fold when using FFR-guidance., (Copyright © 2011. Published by Elsevier Inc.)
- Published
- 2011
- Full Text
- View/download PDF
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