James R. Edgerton M.D.

Jacobs, J.P., Shahian, D.M., Grau-Sepulveda, M., O’Brien, S.M., Pruitt, E.Y., Bloom, J.P., Edgerton, J.R., Kurlansky, P.A., Habib, R.H., Antman, M.S., Cleveland, J.C., Jr., Fernandez, F.G., Thourani, V.H. and Badhwar, V. (2021). “Current Penetration, Completeness, and Representativeness of The Society of Thoracic Surgeons Adult Cardiac Surgery Database.” Ann Thorac Surg Jun 18;S0003-4975(21)01039-0. [Epub ahead of print].

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BACKGROUND: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is the largest cardiac surgical database in the world. Linked data from STS ACSD and the CMS Medicare database were used to determine contemporary completeness, penetration, and representativeness of STS ACSD. METHODS: Using variables common to both STS and CMS databases, STS procedures were linked to CMS data for all CMS CABG discharges between 2000 and 2018, inclusive. For each CMS CABG hospitalization, it was determined whether a matching STS record existed. RESULTS: Center-level penetration (number of CMS sites with at least one matched STS participant divided by total number of CMS CABG sites) increased from 45% in 2000 to 95% in 2018. In 2018, 949 of 1,004 CMS CABG sites (95%) were linked to an STS site. Patient-level penetration (number of CMS CABG hospitalizations at STS sites divided by total number of CMS CABG hospitalizations) increased from 51% in 2000 to 97% in 2018. In 2018, 68,584 of 70,818 CMS CABG hospitalizations (97%) occurred at an STS site. Completeness of case inclusion at STS sites (number of CMS CABG cases at STS sites linked to STS records divided by total number of CMS CABG cases at STS sites) increased from 88% in 2000 to 98% in 2018. In 2018, 66,673 of 68,108 CMS CABG hospitalizations at STS sites (98%) were linked to an STS record. CONCLUSIONS: Linkage of STS and CMS databases demonstrates high and increasing penetration and completeness of STS ACSD. STS ACSD now includes 97% of CABG in USA.

Edgerton, J.R. and Damiano, R.J., Jr. (2021). “Commentary: What is the measure of success for atrial fibrillation ablation? Is a reduction in arrhythmia burden sufficient?” J Thorac Cardiovasc Surg.

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In this issue of the Journal, Li and colleagues1 follow a small cohort of patients with paroxysmal atrial fibrillation (PAF) and previous cerebrovascular or peripheral thromboembolism, without previous intervention, who underwent stand-alone thoracoscopic pulmonary vein isolation and left atrial appendage excision. They compared these patients with a smaller group who opted for medical management. After controlling for CHA2DS2-VASc score (ie, congestive heart failure; hypertension; age ≥75 years; diabetes mellitus, stroke, or transient ischemic attack; vascular disease; age 65-74 years; sex category), the authors found that pulmonary vein isolation delayed progression of PAF. [No abstract; excerpt from Commentary].

Edgerton, J. R. (2020). “Commentary: Ptolemy versus Copernicus: The times they are a-changin’.” J Thorac Cardiovasc Surg Apr 6. pii. [Epub ahead of print].

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As we move to patient-centered medicine, outcomes we track must be those meaningful to patients and their families. To do this, we must transition from proceduralists to practicing disease management. (Excerpt from text; no abstract available.)

Edgerton, J. R. (2020). “Current State of Surgical Left Atrial Appendage Exclusion: How and When.” Card Electrophysiol Clin 12(1): 109-115.

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Left atrial appendage exclusion is efficacious for stroke prophylaxis in patients with atrial fibrillation. Surgical excision provides reliable left atrial appendage exclusion, whereas surgical occlusion does not. Specifically, 2-layer internal suture ligation has a high failure rate. Left atrial appendage exclusion concomitant to another cardiac surgical procedure is indicated in patients with atrial fibrillation but not in patients without baseline atrial fibrillation. Studies currently underway will further define the role of concomitant surgical left atrial appendage exclusion, especially for the population without baseline atrial fibrillation but at high risk of developing postoperative atrial fibrillation.

Squiers, J., H. Baumgarten, G. Filardo, D. Sass, B. Pollock, J. Edgerton, R. Marcel, J. M. DiMaio and R. L. Smith (2019). “Prospective Evaluation of a Blood Transfusion Protocol for Patients Undergoing Cardiac Surgery.” Ann Thorac Surg Nov 23. [Epub ahead of print].

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BACKGROUND: The Society of Thoracic Surgeons clinical practice guidelines recommend the creation of an interdisciplinary blood management team to implement protocols for improved blood transfusion practices. We report our center’s prospective evaluation of a blood transfusion protocol. METHODS: An interdisciplinary blood management team developed protocols for transfusion of packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate. The protocols were prospectively evaluated by tracking transfusions administered to consecutive patients undergoing cardiac surgery, and the primary outcome of interest was the mean number of adjusted units of blood product transfused per patient. Protocol implementation phases were separated by washout phases to control for a potential Hawthorne effect associated with protocol implementation. Protocol compliance was also assessed. RESULTS: A total of 1441 patients underwent cardiac surgery during the 16-month study period. Although there was no statistically significant reduction in transfusions with an unadjusted analysis, there was a significant trend towards reduction of mean adjusted total units transfused per patient over the course of the study period (p<0.001). The mean adjusted total units transfused per patient were significantly less during the second washout phase (2.8 units, 95%CI 2.3-3.3) and second protocol phase (2.8 units, 95%CI 2.32-3.27) as compared to the initial baseline survey phase (3.6 units, 95%CI 3.1-4.1; p<0.05 for both comparisons). Only 55.2% of all units were transfused in compliance to the implemented protocols: platelets (46.8%), cryoprecipitate (32.1%), packed red blood cells (60.7%), and fresh frozen plasma (53.6%). CONCLUSIONS: During a prospective evaluation of blood transfusion protocols, a risk-adjusted analysis demonstrated a reduction in transfusions despite poor protocol compliance.