7 research outputs found

    A randomized prospective multicenter trial for stroke prevention by prophylactic surgical closure of the left atrial appendage in patients undergoing bioprosthetic aortic valve surgery--LAA-CLOSURE trial protocol

    Get PDF
    Patients undergoing surgical aortic valve replacement (SAVR) are at high risk for atrial fibrillation (AF) and stroke after surgery. There is an unmet clinical need to improve stroke prevention in this patient population. The LAA-CLOSURE trial aims to assess the efficacy and safety of prophylactic surgical closure of the left atrial appendage for stroke and cardiovascular death prevention in patients undergoing bioprosthetic SAVR. This randomized, open-label, prospective multicenter trial will enroll 1,040 patients at 13 European sites. The primary endpoint is a composite of cardiovascular mortality, stroke and systemic embolism at 5 years. Secondary endpoints include cardiovascular mortality, stroke, systemic embolism, bleed fulfilling academic research consortium (BARC) criteria, hospitalization for decompensated heart failure and health economic evaluation. Sample size is based on 30% risk reduction in time to event analysis of primary endpoint. Prespecified reports include 30-daysafety analysis focusing on AF occurrence and short-term outcomes and interim analyses at 1 and 3 years for primary and secondary outcomes. Additionally, substudies will be performed on the completeness of the closure using transesophageal echocardiography/cardiac computed tomography and long-term ECG recording at one year after the operation. (Am Heart J 2021;237:127-134.

    FrĂ„n det lokala till det globala – kulturer och kulturmöten utifrĂ„n det historiska UppĂ„kra

    No full text
    Syftet med detta utvecklingsarbete har varit att skapa en pedagogisk planering, riktad mot Ă„rskurserna 1-3, med utgĂ„ngspunkt i det stoff som det historiska UppĂ„kra erbjuder. Arbetet har initierats pĂ„ uppdrag av UppĂ„kra Arkeologiska Center (UAC), och planeringen Ă€r tĂ€nkt att kunna erbjudas av UAC till de skolklasser som intresserar sig för UppĂ„kra, och som vill arbeta vidare med omrĂ„det i klassrummet. I samtal med vĂ„ra kontaktpersoner pĂ„ UAC valde vi att rikta in oss pĂ„ de arabiska silvermynt som arkeologerna funnit i samband med utgrĂ€vningarna vid UppĂ„kra. Vi kĂ€nde att denna nisch gav oss bra möjligheter för att inkorporera och arbeta med de pedagogiska inriktningar Viktigt för oss var att inkludera den interkulturella pedagogiken i planeringen, samt att utnyttja den geografiskt lokala historien för att nĂ„ ut till den mer globala historien. VĂ„r strĂ€van var att via planeringen kunna frĂ€mja ett adekvat och aktuellt historiemedvetande, genom att via interkulturell pedagogik peka pĂ„ historiska kulturmöten och tidiga former av globalisering. Efter att ha utformat en pedagogisk planering kring den centrala inriktningen – arabiska silvermynt – insĂ„g vi snabbt att resultatet behövde kompletteras med ytterligare lektionspass. SĂ„ledes valde vi att expandera den pedagogiska planeringen, för att inkludera en tvĂ„ relaterade och grundlĂ€ggande aspekter. DĂ€rmed tillkom tvĂ„ lektionspass, som behandlar hur arkeologi fungerar och vad det har för betydelse för historien, samt en övergripande introduktion av det historiska UppĂ„kra

    The prevalence of moderate mitral regurgitation in patients undergoing CABG

    No full text
    Objective. The aim of this study was to determine the prevalence of moderate ischemic mitral regurgitation (IMR) in the contemporary CABG population. We also aimed to correlate the effective regurgitant orifice area (ERO) of any regurgitant mitral valve in patients with coronary artery disease with the semiquantitative integrated scale of IMR. Design. From March 15 through June 15, 2006, 510 consecutive CABG patients in three tertiary centres were included in the study. All patients showing any sign of mitral regurgitation (MR) at the referring hospital underwent a preoperative transthoracic echocardiographic estimation of the degree of MR using the integrated scale (1-4) and ERO. Results. IMR was found in 141 patients (28%). The prevalence of moderate 2+ or worse IMR was 4% (95% CI; 2.5-6.1%) and the ERO corresponding to 2+ IMR or more ranged from 5 to 30 mm2. Fourteen patients had an ERO between 15-30 mm2. Conclusions. According to our study, patients with moderate IMR, defined as an ERO between 15-30 mm2, account for only 2.7% (95% CI; 1.5-4.7%) of a non-emergency CABG population

    Moderate mitral regurgitation in patients undergoing CABG - the MoMIC trial

    No full text
    Background. The presence of mild to moderate ischemic mitral regurgitation (IMR) marks a significantly reduced long-term survival and increased hospitalizations due to heart-failure. However, it is common practice in many institutions to refrain from repairing the mitral valve in these patients. There are no available conclusive data to support this practice, and thus there is a need for an adequately powered randomized trial. Study design. The Moderate Mitral Regurgitation In Patients Undergoing CABG (MoMIC) trial is the first international multi-center, large-scale study to clarify whether moderate IMR in CABG patients should be corrected. A total of 550 CABG patients with moderate IMR are to be randomized to treatment of either CABG alone or CABG plus mitral valve correction. The primary end point is a composite end point of mortality and rehospitalization for heart failure at five years. The inclusion and randomization of patients started in February 2008. Implication. If correction of moderate IMR in CABG patients proves to be the superior strategy, most patients should be treated accordingly

    A Swedish consensus on the surgical treatment of concomitant atrial fibrillation

    No full text
    Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF

    A randomized prospective multicenter trial for stroke prevention by prophylactic surgical closure of the left atrial appendage in patients undergoing bioprosthetic aortic valve surgery--LAA-CLOSURE trial protocol

    Get PDF
    Patients undergoing surgical aortic valve replacement (SAVR) are at high risk for atrial fibrillation (AF) and stroke after surgery. There is an unmet clinical need to improve stroke prevention in this patient population. The LAA-CLOSURE trial aims to assess the efficacy and safety of prophylactic surgical closure of the left atrial appendage for stroke and cardiovascular death prevention in patients undergoing bioprosthetic SAVR. This randomized, open-label, prospective multicenter trial will enroll 1,040 patients at 13 European sites. The primary endpoint is a composite of cardiovascular mortality, stroke and systemic embolism at 5 years. Secondary endpoints include cardiovascular mortality, stroke, systemic embolism, bleed fulfilling academic research consortium (BARC) criteria, hospitalization for decompensated heart failure and health economic evaluation. Sample size is based on 30% risk reduction in time to event analysis of primary endpoint. Prespecified reports include 30-day safety analysis focusing on AF occurrence and short-term outcomes and interim analyses a
    corecore