20966 research outputs found
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Project #073: Improving Patient Outcomes: Preventing Pneumonia-Related MRSA Bacteremia through a Multidisciplinary Approach
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1009/thumbnail.jp
Project #099: Reducing Anesthetic Greenhouse Gas Emissions Across Henry Ford Hospitals
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1016/thumbnail.jp
Project #054: Safeguarding the vulnerable: streamlining triage to rooming in the ED
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1006/thumbnail.jp
Project #098: Catheter-Associated Urinary Tract Infection Reduction: Turning the Tide through a Comprehensive and Multidisciplinary Approach
Get PDFhttps://scholarlycommons.henryford.com/qualityexpo2025/1015/thumbnail.jp
Project #126: Optimizing Throughput and Recovery Capacity in the Cath and EP Labs: A Multiphase Workflow Redesign
No full texthttps://scholarlycommons.henryford.com/qualityexpo2025/1024/thumbnail.jp
Mechanical circulatory support in high-risk elective PCI: rationale and design of the PROTECT IV trial
No full textCoronary artery disease (CAD) is the leading cause of heart failure with reduced ejection fraction (HFrEF). Coronary artery bypass grafting (CABG) improves long-term mortality in HFrEF. Percutaneous coronary intervention (PCI) is often performed as an alternative to CABG in patients at high surgical risk. However, in patients with HFrEF and limited myocardial reserve, PCI may result in haemodynamic instability, increasing risk and precluding optimal revascularisation. Mechanical circulatory support (MCS) during high-risk PCI may enhance haemodynamic stability during the procedure and enable complete revascularisation. We thus performed the PROTECT IV trial to determine whether PCI with routine use of the Impella CP microaxial flow pump improves early and late outcomes in patients with HFrEF and complex CAD compared with PCI with or without use of an intra-aortic balloon pump (IABP). PROTECT IV is a prospective, multicentre, randomised, parallel-controlled, open-label, superiority trial with an adaptive design. Patients with complex CAD and left ventricular ejection fraction ≤40% (n=1,252) deemed at excessive surgical risk for bypass grafting by the Heart Team will be randomised in a 1:1 ratio to PCI with Impella CP versus PCI with or without an IABP. The primary endpoint is the composite of all-cause death, stroke, myocardial infarction, unplanned clinically driven revascularisation, durable left ventricular assist device implant or heart transplant, or other hospitalisation for cardiovascular causes at 3-year follow-up, with at least 1-year follow-up in all patients. Prespecified substudies will evaluate the impact of MCS on renal function, the procedural role of right heart catheterisation, and the utility of myocardial viability assessment. The PROTECT IV trial will determine whether routine MCS with Impella CP during high-risk PCI improves the prognosis of patients with complex CAD and HFrEF
A Statewide Quality Initiative to Promote Aortic Annular Enlargement: Leading An Evolving Paradigm Shift
No full textBACKGROUND: Aortic annular enlargement (AAE) represents an important adjunct strategy during aortic valve replacement (AVR) enabling implantation of larger-size prosthesis to prevent patient-prosthesis mismatch. This study evaluates the results of a statewide quality improvement intervention (QII) to increase AAE adoption, including the novel Y-incision technique.
METHODS: Using The Society of Thoracic Surgeons database, we identified patients undergoing AVR with or without AAE from January 2018 to December 2023, excluding emergent and endocarditis cases. A QII was initiated in September 2021 and again, May 2023 featuring wet-lab training in AAE techniques. Patients were categorized into pre-QII (before September 2021) and post-QII groups. Primary endpoints were AVR+AAE incidence and median prosthesis size; secondary endpoints included 30-day mortality, transfusions, and morbidity. Sensitivity analyses were performed on isolated AVR+AAE cases.
RESULTS: Totally, 817 patients were included (pre-QII: 330; post-QII: 487) and 11.6% of the audited operative notes were reassigned to the QII Y-incision subgroup. Post-QII patients showed increased AVR+AAE incidence (7% vs. 19%; p\u3c 0.001), with isolated AVR+AAE cases rising from 8% to 23% (p\u3c 0.001). Median prosthesis size increased from 23 to 25 (p\u3c 0.001). Y-incision adoption rose significantly (20% vs. 70%; p\u3c 0.001), with more surgeons implementing the technique in the post-QII group (18 vs. 35). No significant differences were observed in secondary endpoints. Sensitivity analyses confirmed findings.
CONCLUSIONS: A pilot QII enhanced AAE adoption during AVR, leading to larger AV prosthesis size without a significant increase in morbidity/mortality. Future research should explore mid- and long-term benefits on patient outcomes, including quality of life and survival
Clinical Experience With a Novel Perfusion Balloon Catheter in Patients With Coronary Artery Perforation: Primary Results From the Ringer Clinical Study
No full textBACKGROUND: The Ringer perfusion catheter (Teleflex) features a novel design with a spiral-shaped inflatable balloon that approximates a hollow cylinder when inflated to manage hemorrhage associated with coronary artery perforation (CAP) during percutaneous coronary intervention while enabling distal perfusion.
METHODS: In a multicenter, prospective, single-arm study, the safety and efficacy of using the Ringer device in the treatment of CAP were assessed. The primary efficacy end point included successful Ringer delivery across the perforation site, angiographic confirmation of no extravasation with balloon inflation, and demonstration of antegrade coronary flow. The primary safety end point was freedom from device-related thrombosis and coronary dissection. Clinical and angiographic outcomes were independently adjudicated.
RESULTS: Among 30 patients with CAP, lesion characteristics included: chronic total occlusion, 50%; severe calcification, 63.3%; lesion length 34.1 ± 23.4 mm. Ellis type II and III perforations occurred in 50% and 30% of patients, respectively. For all patients, the primary efficacy end point was 73.3% by intention to treat analysis. However, among the 26 patients with successful Ringer delivery across the perforation site, the primary end point was 84.6%. In this latter group, acute resolution of contrast extravasation was 84.6%, and maintenance of thrombolysis in myocardial infarction 2/3 antegrade flow during device inflation was 100%. No device-related safety events were observed.
CONCLUSIONS: Treatment of CAP with a novel perfusion balloon catheter achieved favorable rates of deliverability and reduction in hemorrhage while maintaining antegrade flow. These results demonstrate that the Ringer perfusion catheter is a safe and effective method to manage CAP until definitive treatment is decided
Transjugular Approach for Evoque Transcatheter Tricuspid Valve Replacement in Patients With Challenging Anatomy.
No full textBACKGROUND: The Evoque system is the first commercially available transcatheter tricuspid valve replacement (TTVR) system in the United States. However, challenging anatomy in real-world patients could preclude successful transfemoral Evoque TTVR. We aim to investigate the feasibility of the transjugular Evoque TTVR in anatomy unsuitable for a transfemoral approach.
METHODS: Eleven patients with challenging anatomy underwent transjugular Evoque TTVR at a high-volume center in the United States from February 2024 to January 2025, following an unsuccessful transfemoral attempt (n=9) or anatomic unsuitability (n=2). Procedural characteristics, intraprocedural success, periprocedural outcomes, echocardiographic findings, and 30-day clinical outcomes were assessed using the Tricuspid Valve Academic Research Consortium definitions. The procedural technique is provided in the accompanying supplement.
RESULTS: Intraprocedural success was achieved in all 11 patients, with reasonable procedural time and no major procedural complications, except for 1 pacemaker implantation. At 30 days, the clinical success rate was 100%. Tricuspid regurgitation was reduced to none-to-trivial in 8 patients, mild in 2 patients, and moderate in 1 patient. There was no stroke, mortality, or rehospitalization. Nine out of 11 patients experienced an improvement in New York Heart Association functional class.
CONCLUSIONS: In the largest single-center cohort of patients reported to date, transjugular Evoque TTVR demonstrated favorable intraprocedural, periprocedural, and short-term clinical outcomes, and was found to be a feasible alternative for patients with anatomy unsuitable for transfemoral Evoque TTVR
