Creighton University School of Medicine
Tripler Army Medical Center - Surgery Residency
Bayne-Jones ACH - General Surgeon
University of Tennessee at Memphis - Cardiothoracic Fellow
Ochsner Clinic Foundation - Cardiac Transplant Fellow
Tacoma General Heart Hospital - Staff Surgeon 2006-2012
Saint Joseph's of Atlanta - Staff Surgeon 2/2012
Ventricular Assist Devices and heart failure
Robotic intracardiac surgery
Robot assisted thoracic surgery
Mitral valve repair techniques - minimally invasive
Sternal and chest wall reconstruction
Minimally invasive surgery for atrial fibrillation
Instrument design
J Thorac Cardiovasc Surg. [4] 2014 Apr;147(4):1202-1210; discussion 1210-1. doi: 10.1016/j.jtcvs.2014.01.004. Epub 2014 Jan 12.Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial.Puskas J [5]1, Gerdisch M [6]2, Nichols D [7]3, Quinn R [8]4, Anderson C [9]3, Rhenman B [10]5, Fermin L [11]5, McGrath M [12]6, Kong B [13]7, Hughes C [14]8, Sethi G [15]9, Wait M [16]10, Martin T [17]11,Graeve A [18]3; PROACT Investigators [19].Author information [4] AbstractOBJECTIVE:
Under Food and Drug Administration investigational device exemption, the Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) has been testing the safety of less aggressive anticoagulation than recommended by the American College of Cardiology/American Heart Association guidelines after implantation of an approved bileaflet mechanical valve.
METHODS:
In this first limb of the PROACT, patients with elevated risk factors for thromboembolism were randomized at 33 US centers to receive lower dose warfarin (test international normalized ratio [INR], 1.5-2.0) or continue standard warfarin (control INR, 2.0-3.0), 3 months after mechanical aortic valve replacement. The INR was adjusted by home monitoring; all patients received 81 mg aspirin daily. Adverse events were independently adjudicated.
RESULTS:
A total of 375 aortic valve replacement patients were randomized into control (n = 190) and test (n = 185) groups from September 2006 to December 2009. The mean age ± standard deviation was 55.2 ± 12.5 years; 79% were men; and 93% were in sinus rhythm preoperatively. Calcific degeneration was present in 67%; active endocarditis was excluded. Concomitant procedures included coronary artery bypass grafting (27%), aortic aneurysm repair (14%), and other (25%). The follow-up duration averaged 3.82 years (755.7 patient-years [pt-yrs] for control; 675.2 pt-yrs for test). The mean INR was 2.50 ± 0.63 for the control and 1.89 ± 0.49 for the test groups (P < .0001). The test group experienced significantly lower major (1.48% vs 3.26%/pt-yr; P = .047) and minor (1.32% vs 3.41%/pt-yr; P = .021) bleeding rates. The incidence of stroke, transient ischemic attack, total neurologic events, and all-cause mortality were similar between the 2 groups.
CONCLUSIONS:
INR can be safely maintained between 1.5 and 2.0 after aortic valve replacement with this approved bileaflet mechanical prosthesis. With low-dose aspirin, this resulted in a significantly lower risk of bleeding, without a significant increase in thromboembolism.
Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Links
[1] https://www.youtube.com/user/charlesandersonmd/featured
[2] https://www.ctsnet.org/user/login?destination=user/408197
[3] https://www.ctsnet.org/sites/default/files/styles/large/public/ismics%20case%20series%20poster.jpg?itok=nsxP7Wbo
[4] https://www.ncbi.nlm.nih.gov/pubmed/24512654?dopt=Abstract#
[5] https://www.ncbi.nlm.nih.gov/pubmed/?term=Puskas%20J%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[6] https://www.ncbi.nlm.nih.gov/pubmed/?term=Gerdisch%20M%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[7] https://www.ncbi.nlm.nih.gov/pubmed/?term=Nichols%20D%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[8] https://www.ncbi.nlm.nih.gov/pubmed/?term=Quinn%20R%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[9] https://www.ncbi.nlm.nih.gov/pubmed/?term=Anderson%20C%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[10] https://www.ncbi.nlm.nih.gov/pubmed/?term=Rhenman%20B%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[11] https://www.ncbi.nlm.nih.gov/pubmed/?term=Fermin%20L%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[12] https://www.ncbi.nlm.nih.gov/pubmed/?term=McGrath%20M%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[13] https://www.ncbi.nlm.nih.gov/pubmed/?term=Kong%20B%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[14] https://www.ncbi.nlm.nih.gov/pubmed/?term=Hughes%20C%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[15] https://www.ncbi.nlm.nih.gov/pubmed/?term=Sethi%20G%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[16] https://www.ncbi.nlm.nih.gov/pubmed/?term=Wait%20M%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[17] https://www.ncbi.nlm.nih.gov/pubmed/?term=Martin%20T%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[18] https://www.ncbi.nlm.nih.gov/pubmed/?term=Graeve%20A%5BAuthor%5D&cauthor=true&cauthor_uid=24512654
[19] https://www.ncbi.nlm.nih.gov/pubmed/?term=PROACT%20Investigators%5BCorporate%20Author%5D
[20] https://www.ctsnet.org/print/home/chaanderson
[21] https://www.ctsnet.org/article/robotic-repair-mitral-endocarditis-preoperative-neurologic-embolic-events
[22] https://www.ctsnet.org/article/robot-assisted-esophageal-leiomyoma-removal
[23] https://www.ctsnet.org/article/robotic-mitral-valve-repair-anterior-leaflet-perforation-and-flail-posterior-leaflet
[24] https://www.ctsnet.org/articles/chaanderson
[25] https://www.ctsnet.org/society/ctsnet
[26] https://www.ctsnet.org/society/ismics
[27] https://www.ctsnet.org/society/sts