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Background— Aortic dissection remains the most common aortic catastrophe. In the endovascular era, the management of acute type B aortic dissection (ATBAD) is undergoing dramatic changes. The aim of this study is to evaluate the long-term outcomes of patients with ATBAD who were treated at our center over a 13-year period. Methods and Results— We reviewed patients with ATBAD between 2001 and 2014, analyzing variables based on status (complicated [c] versus uncomplicated [u]) and treatment modalities. We defined cATBAD as rupture, expansion of diameter on imaging during the admission, persistent pain, or clinical malperfusion leading to a deficit in cerebral, spinal, visceral, renal, or peripheral vascular territories at presentation or during initial hospitalization. Postoperative outcomes were defined as deficits not present before the intervention. Outcomes were compared between the groups by use of Kaplan-Meier and descriptive statistics. We treated 442 patients with ATBAD. Of those 442, 60.6% had uATBAD and were treated medically, and 39.4% had cATBAD, of whom 39.0% were treated medically to 30.0% with open repair, 21.3% with thoracic endovascular aortic repair, and 9.7% with other open peripheral procedures. Intervention-free survival at 1 and 5 years was 84.8% and 62.7% for uATBAD, 61.8% and 44.0% for cATBAD-medical, 69.2% and 47.2% for cATBAD-open, and 68.0% and 42.5% for cATBAD–thoracic endovascular aortic repair, respectively (P=0.001). Overall survival was significantly related primarily to complicated presentation. Conclusions— In our experience, early and late outcomes of ATBAD were dependent on the presence of complications, with cATBAD faring worse. Although uATBAD was associated with favorable early survival, late complications still occurred, mandating radiographic surveillance and open or endovascular interventions. Prospective trials are required to better determine the optimal therapy for uATBAD.

The “Late-Breaking Clinical Trial and Clinical Science Special Reports Abstracts From the American Heart Association’s Scientific Sessions 2016; Late-Breaking Abstracts in Resuscitation Science From the Resuscitation Science Symposium …

Hall B Abstracts 21768–21828 21768 The Resynchronization/Defibrillation for Ambulatory Heart Failure Trial (RAFT) Anthony S Tang, George A Wells, Univ of Ottawa Heart Institute, Ottawa, Canada; Mario Talajic, Institut de Cardiologie de Montreal, Montreal, Canada; J. Malcolm O Arnold, Univ Hosp, London Health Sciences Cntr, London, Canada; Robert Sheldon, Libin Cardiovascular Institute of Alberta, Calgary, Canada; Stuart Connolly, Hamilton Health Science Cntr, Hamilton, Canada; Stefan H Hohnloser, J.W. Goethe Universitat, Frankfurt, Germany; Graham Nichol, Univ of Washington-Harborview Med Cntr, Seattle, WA; David H Birnie, Univ of Ottawa Heart Institute, Ottawa, Canada; John L Sapp, Queen Elizabeth II Health Sciences Cntr, Halifax, Canada; Raymond Yee, London Health Sciences Cntr, London, Canada; Jeffrey S Healey, McMaster Univeristy, Hamilton, Canada; Jean L Rouleau; Universite de Montreal, Montreal, Canada The role of cardiac resynchronization therapy (CRT) in patients with mild to moderate heart failure (HF) symptoms requiring an implantable cardioverter-defibrillator therapy (ICD) remains uncertain. We hypothesized that the addition of CRT to optimal medical therapy and ICD reduces mortality and HF hospitalization in patients with mild to moderate HF symptoms, LV dysfunction (EF less than or equal to 30%) and wide QRS duration. Design: This study is a prospective multicenter (34 sites in Canada, Europe, Australia, and Turkey) randomized double-blinded controlled clinical trial. Patients were randomized to receive an ICD (control) or ICD with CRT in a 1:1 ratio in addition to optimal heart failure medical therapy. The primary endpoint is a composite of all cause mortality and adjudicated HF hospitalization (defined as an admission to hospital for >24 hrs with a diagnosis of worsening HF) whichever comes first. Secondary endpoints include all cause mortality at anytime during the study, HF hospitalization, quality of life and cost effectiveness of therapy. Sample size: A total of 1798 patients satisfying the inclusion/exclusion criteria were enrolled between …

The Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group was commissioned by the American Heart Association (AHA) to provide a forum to address important and emerging issues in this multidisciplinary area of clinical science. The working group was a primary outgrowth of the AHA Atherosclerotic Vascular Disease Conference held in Boston, Mass, in July 2002. It was created in recognition of the fact that atherosclerosis is a systemic disease with important sequelae in many regional circulations in addition to the heart, including the brain, kidneys, mesentery, and limbs. Its mission is to provide a forum for the multiple disciplines engaged in research, evaluation, and management of patients with noncoronary atherosclerosis. The goals of the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group are to develop a strategy to increase awareness of atherosclerotic vascular disease, identify important gap areas in knowledge that require further clinical investigation, and develop programs that will facilitate prevention and treatment of peripheral atherosclerotic diseases. Developments in research and technology that are relevant to atherosclerotic vascular disease are emerging rapidly. As a result, greater opportunities to translate science to clinical practice are available. The American College of Cardiology/AHA practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) provide many evidenced-based recommendations for diagnosing and treating patients with atherosclerotic vascular diseases.1 Nevertheless, in some areas, the evidence has not matured sufficiently for definitive guidelines. Some of these areas have engendered considerable controversy among practitioners. Among these are the efficacy and outcome of screening programs for vascular disease and the appropriate and timely use of endovascular interventions. Accordingly, the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group convened the second AHA conference on Atherosclerotic Vascular Disease, which took place in Boston, Mass, in July 2006. The conference was also sponsored by the …

The survival of patients with acute myocardial infarction (MI) has improved considerably during the past 15 years with the advent of thrombolytic therapy, including better utilization of anticoagulants, aspirin, and cardioprotective drugs such as β-blockers and ACE inhibitors. Despite this improvement, mortality rates after MI continue to demonstrate an early rise during the first 3 months, with a slower but steady increase afterward.1 The principal cardiac factors influencing survival after MI are the size of the infarct and its impact on left ventricular (LV) function, the presence of residual ischemia, recurrent infarction, and ventricular arrhythmias. These factors can coexist in the same patient and exert a negative synergistic effect on survival. There is general consensus that reduction of the risk of recurrent ischemia improves long-term survival of post-MI patients. However, there is controversy regarding the best strategy for achieving this, particularly in low-risk patients with an uncomplicated MI. A conservative strategy uses noninvasive testing to identify important risk factors and modify therapy accordingly, including the selective use of coronary revascularization procedures, whereas a more aggressive strategy involves the routine use of coronary angiography followed by revascularization of areas supplied by significant stenotic lesions. Ejection fraction is without doubt a strong predictor of mortality in patients with acute MI. Mortality rates increase rapidly as ejection fraction falls below 40%.2 Currently, ejection fraction is determined primarily with noninvasive techniques. In 1979, Theroux and associates3 reported on the use of submaximal exercise testing early after MI and demonstrated the negative impact of exercise-induced ischemia on long-term outcome. Since their original report, multiple studies have shown that post-MI patients with demonstrable ischemia are at high risk for cardiac events regardless of the method used for inducing or detecting ischemia.4 5 6 7 However, methods with higher sensitivity for ischemia detection, …