Society for Cardiovascular Magnetic Resonance 2019 Case of the Week series.

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site ( https://www.scmr.org ) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.

Right anterior mini thoracotomy for redo cardiac surgery: case series from North America and Europe.

Background: Right anterior mini thoracotomy (RAMT) for aortic valve replacement (AVR) is a minimally invasive procedure that avoids sternotomy. Herein, we report the outcomes of patients who underwent redo-cardiac via a RAMT approach for AVR. Methods: This case series reports the clinical outcomes of 14 consecutive redo operations, done in Calgary (Canada) and Gdansk (Poland) between 2020 and 2023. Primary outcomes were 30-day mortality and disabling stroke. Secondary outcomes included surgical times, hemodynamics, permanent pacemaker implantation (PPM), length of ICU and hospital stay, new post-operative atrial fibrillation (POAF), post-operative blood transfusion, incidence of acute respiratory distress syndrome (ARDS), rate of continuous renal replacement therapy (CRRT) and/or dialysis, and chest tube output in the first 12-hours after surgery. Results: Nine patients were male, and the mean age was 64.36 years. There were no deaths, while one patient had a disabling stroke postoperatively. Mean cardiopulmonary bypass and cross clamp-times were 136 min and 90 min, respectively. Three patients needed a PPM, 3 patients needed blood transfusions, and 2 developed new onset POAF. Median lengths of ICU and hospital stays were 2 and 12 days, respectively. There was no incidence of paravalvular leak greater than trace and the average transvalvular mean gradient was 12.23 mmHg. Conclusion: The number of patients requiring redo-AVR is increasing. Redo-sternotomy may not be feasible for many patients. This study suggests that the RAMT approach is a safe alternative to redo-sternotomy for patients that require an AVR.

Increased Travel Time to the Tertiary Centre Is Associated With Decreased Long-term Survival Following Ascending Aortic Operations.

BACKGROUND: The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in Nova Scotia. METHODS: A retrospective analysis of patients undergoing elective and emergent ascending thoracic aortic operations from 2005 to 2015 was carried out. Patient's residential geographic coordinates were used to calculate travel time to the tertiary care centre, and patients who resided < 1 hour vs ≥ 1 hour were compared. Multivariable logistic regression was performed to determine the effect of travel time on in-hospital outcomes. Cox-proportional hazard modelling and Kaplan-Meier survival estimates were created to determine the effect on long-term survival. RESULTS: A total of 476 patients underwent ascending thoracic aortic surgery from 2005 to 2015. Patients who resided < 1 hour from the tertiary care centre vs patients who resided ≥ 1 hour had similar rates of in-hospital mortality (4.4% vs 6.1%, P = 0.42), in-hospital composite complications (66.7% vs 67.7%, P = 0.80), hospital length of stay (median 9 days; interquartile range [7-16] vs 10 [7-17], P = 0.41), and discharge disposition other than home (9.7% vs 11.7%, P = 0.55). Compared with patients who resided < 1 hour from the tertiary centre, patients who resided ≥ 1 hour were at higher risk for long-term mortality (hazard ratio, 2.19; 95% confidence interval, 1.13-4.28; P = 0.02). CONCLUSIONS: Patients who reside remotely from the tertiary centre experience equivalent in-hospital outcomes but decreased long-term survival following ascending aortic operations. These findings may guide resource expansion for postoperative follow-up.

Sex Differences in Trends in Incidence of Thoracic Aortic Aneurysm Repair and Aortic Dissection: 2005-2015.

Background: The purpose of this study was to examine trends in the incidence of thoracic aortic aneurysm (TAA) repair and aortic dissection. Methods: A retrospective study was conducted of patients from the period 2005-2015 with thoracic aortic disease. Unadjusted mortality was compared in women vs men. Rates of scheduled TAA repair, dissection events, acute type A aortic dissection (TAAD) repair, and aorta-related mortality were obtained from our institution's clinical registry and administrative data sources and used to calculate the age-adjusted incidence for each sex, adjusted to the Canadian standard population. Weighted linear regression was performed to analyze trends over time. Results: A total of 382 scheduled TAA repair operations, 345 dissection events, 85 TAAD repairs, and 182 aorta-related mortalities were identified. Women accounted for 23% of TAA repairs, 39% of dissection events, 22% of TAAD repairs, and 45% of aorta-related mortalities. The incidence of TAA repair was 3.5 per 100,000 person-years (95% confidence interval [CI]: 3.2-3.9), and increased in men (P = 0.02) but not women (P = 0.10) over time. The incidence of aortic dissection was 3.4 per 100,000 (95% CI: 3.1-3.8) and was stable over time (P = 0.43). The average annual age-adjusted incidence of TAAD repair was 0.8 per 100,000 (95% CI: 0.6-1.0) and increased over time (P = 0.001). The overall incidence of aorta-related mortality was 1.8 per 100,000 (95% CI: 1.5-2.0) and decreased over time (P = 0.02). Conclusion: The incidence of TAA repair is increasing in men but not women. Although aorta-related mortality is decreasing overall, disparities exist between the male and female population.

Introduction: L'objectif de cette étude était d'examiner les tendances relatives à l'incidence des réparations d'anévrisme de l'aorte thoracique (AAT) et de dissection aortique. Méthodes: Nous avons mené une étude rétrospective de patients atteints d'une maladie de l'aorte thoracique de la période 2005-2015. Nous avons comparé la mortalité non ajustée entre les femmes et les hommes. Nous avons obtenu les taux de réparations planifiées d'AAT, de dissections, de dissections aortiques de type A (DATA) à la phase aiguë et de mortalité d'origine aortique du registre clinique de notre établissement et des sources de données administratives, et les avons utilisés pour calculer l'incidence ajustée selon l'âge pour chacun des sexes, ajustée à la population canadienne type. Nous avons effectué une régression linéaire pondérée pour analyser les tendances temporelles. Résultats: Nous avons recensé un total de 382 réparations planifiées d'AAT, 345 dissections, 85 réparations de DATA et 182 cas de mortalité d'origine aortique. Les femmes représentaient 23 % des cas de réparation d'AAT, 39 % des cas de dissection, 22 % des cas de réparations de DATA et 45 % des cas de mortalité d'origine aortique. L'incidence des réparations d'AAT était de 3,5 par 100 000 années-personnes (intervalle de confiance [IC] à 95 % : 3,2-3,9) et augmentait chez les hommes (P = 0,02), mais non chez les femmes (P = 0,10) avec le temps. L'incidence des dissections aortiques était de 3,4 par 100 000 (IC à 95 % : 3,1-3,8) et était stable au fil du temps (P = 0,43). L'incidence moyenne annuelle selon l'âge de réparations de DATA était de 0,8 par 100 000 (IC à 95 % : 0,6-1,0) et augmentait avec le temps (P = 0,001). L'incidence globale de mortalité d'origine aortique était de 1,8 par 100 000 (IC à 95 % : 1,5-2,0) et diminuait avec le temps (P = 0,02). Conclusion: L'incidence des réparations d'AAT augmente chez les hommes, mais non chez les femmes. Bien que la mortalité d'origine aortique tende dans l'ensemble à diminuer, il existe des disparités entre la population masculine et la population féminine.

Minimally Invasive Hybrid Approach to High Risk Mitral Disease With Severe Mitral Annular Calcification.

Severe circumferential mitral annular calcification (MAC) remains a significant challenge, complicating surgical treatment of mitral valve disease. Transcatheter treatment options are attractive; however, they remain fraught with risks of annular fixation, paravalvular leak, atrioventricular-groove disruption, and left-ventricular outflow tract obstruction. We describe a novel minimally invasive hybrid technique of transcatheter mitral valve replacement in a patient with severe circumferential MAC.

Cardiac Resynchronization in Women: A Substudy of the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial.

OBJECTIVES: This study sought to evaluate the effect of cardiac resynchronization therapy with defibrillator (CRT-D) as compared with implantable cardioverter-defibrillator (ICD) on mortality, heart failure (HF) hospitalization, and ventricular arrhythmia in women versus men. BACKGROUND: CRT-D has demonstrated reduced mortality and HF hospitalizations with greater benefit observed in women compared with men. However, whether CRT-D prevented ventricular arrhythmias in women compared with men was unclear. METHODS: The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1,798 patients to an ICD or CRT-D. In this post hoc analysis, women and men were compared by randomized group. By using a multivariable model, the outcomes of death and HF hospitalization and incidence of ventricular arrhythmia were compared between men and women. RESULTS: There were 1,490 (83%) men (732, ICD; 758, CRT-D) and 308 (17%) women (172, ICD; 136, CRT-D) included in the analysis. Women with CRT-D had a significantly reduced incidence of death and HF hospitalization compared with men with CRT-D (hazard ratio: 0.52; 95% confidence interval: 0.33 to 0.81; p < 0.001) on multivariable analysis. Women with a primary prevention indication and CRT-D had the lowest rate of ventricular arrhythmia compared with men (hazard ratio: 0.59; 95% confidence interval: 0.39 to 0.91; p = 0.016). CONCLUSIONS: Women have improved rates of death and HF hospitalization with CRT-D and were less likely to experience ventricular arrhythmia when compared with men, after adjusting for differences in baseline characteristics over a prolonged follow-up. Whether these improved outcomes reflect inherent sex differences in the underlying myocardial substrate resulting in an enhanced response to CRT-D requires further research.