Chawannuch Ruaengsri

All Publications

• Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair Mid-Term Outcomes From the CUTTING-EDGE International Registry JACC-CARDIOVASCULAR INTERVENTIONS Kaneko, T., Hirji, S., Zaid, S., Lange, R., Kempfert, J., Conradi, L., Hagl, C., Borger, A., Taramasso, M., Nguyen, C., Ailawadi, G., Shah, S., Smith, L., Anselmi, A., Romano, A., Ben Ali, W., Ramlawi, B., Grubb, J., Robinson, B., Pirelli, L., Chu, W., Andrea, M., Obadia, J., Gennari, M., Garatti, A., Tchetche, D., Nazif, M., Bapat, N., Modine, T., Denti, P., Tang, H., CUTTING-EDGE Investigators 2021; 14 (18): 2010-2021

  Abstract

  The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER).Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking.Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year.From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery.In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes.

  View details for DOI 10.1016/j.jcin.2021.07.029

  View details for Web of Science ID 000704941800001

  View details for PubMedID 34556275

• Commentary: Twenty-first century adult cardiac surgery training: Modernization. The Journal of thoracic and cardiovascular surgery Ruaengsri, C., Grubb, K. J. 2021

  View details for DOI 10.1016/j.jtcvs.2021.03.084

  View details for PubMedID 33933260

• Bipolar Radiofrequency Ablation on Explanted Human Hearts: How to Ensure Transmural Lesions ANNALS OF THORACIC SURGERY Khiabani, A. J., MacGregor, R. M., Manghelli, J. L., Ruaengsri, C., Carter, D., Melby, S. J., Schuessler, R. B., Damiano, R. J. 2020; 110 (6): 1933-1940

  Abstract

  Bipolar radiofrequency (RF) clamps have been shown to be capable of reproducibly creating transmural lesions with a single ablation in animal models. Unfortunately in clinical experience the bipolar clamps have not been as effective and often require multiple ablations to create conduction block. This study created a new experimental model using fresh, cardioplegically arrested human hearts turned down for transplant to evaluate the performance of a nonirrigated bipolar RF clamp.Nine human hearts turned down for transplant were harvested, and the Cox-Maze IV lesion set was performed with a nonirrigated bipolar RF clamp. In the first 7 hearts a single ablation was performed for each lesion. In the last 2 hearts a set of 2 successive ablations without unclamping were performed. The heart tissue was stained with 2,3,5-triphenyl-tetrazolium chloride. Each ablation lesion was cross-sectioned to assess lesion depth and transmurality.A single ablation with the bipolar RF clamp resulted in 89% (469/529) of the histologic sections and 65% (42/65) of the lesions being transmural. Of the nontransmural sections, 92% occurred in areas with epicardial fat. Performing 2 successive ablations without unclamping resulted in 100% of the cross-sections (201/201) and lesions (25/25) being transmural.A single ablation failed to create a transmural lesion 35% of the time, and this was associated with the presence of epicardial fat. Two successive ablations without unclamping resulted in 100% lesion transmurality using the bipolar RF clamp.

  View details for DOI 10.1016/j.athoracsur.2020.04.079

  View details for Web of Science ID 000590853100053

  View details for PubMedID 32522634

  View details for PubMedCentralID PMC7669627

• The hemodynamic and atrial electrophysiologic consequences of chronic left atrial volume overload in a controllable canine model JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Ruaengsri, C., Schill, M. R., Lancaster, T. S., Khiabani, A. J., Manghelli, J. L., Carter, D. I., Greenberg, J. W., Melby, S. J., Schuessler, R. B., Damiano, R. J. 2018; 156 (5): 1871-+

  Abstract

  The purpose of this study was to determine the effects of chronic left atrial volume overload on atrial anatomy, hemodynamics, and electrophysiology using a titratable left ventriculoatrial shunt in a canine model.Canines (n = 16) underwent implantation of a shunt between the left ventricle and the left atrium. Sham animals (n = 8) underwent a median sternotomy without a shunt. Atrial activation times and effective refractory periods were determined using 250-bipolar epicardial electrodes. Biatrial pressures, systemic pressures, left atrial and left ventricle diameters and volumes, atrial fibrillation inducibility, and durations were recorded at the initial and at 6-month terminal study.Baseline shunt fraction was 46% ± 8%. The left atrial pressure increased from 9.7 ± 3.5 mm Hg to 13.8 ± 4 mm Hg (P < .001). At the terminal study, the left atrial diameter increased from a baseline of 2.9 ± 0.05 cm to 4.1 ± 0.6 cm (P < .001) and left ventricular ejection fraction decreased from 64% ± 1.5% to 54% ± 2.7% (P < .001). Induced atrial fibrillation duration (median, range) was 95 seconds (0-7200) compared with 0 seconds (0-40) in the sham group (P = .02). The total activation time was longer in the shunt group compared with the sham group (72 ± 11 ms vs 62 ± 3 ms, P = .003). The right atrial and not left atrial effective refractory periods were shorter in the shunt compared with the sham group (right atrial effective refractory period: 156 ± 11 ms vs 141 ± 11 ms, P = .005; left atrial effective refractory period: 142 ± 23 ms vs 133 ± 11 ms, P = .35).This canine model of mitral regurgitation reproduced the mechanical and electrical remodeling seen in clinical mitral regurgitation. Left atrial size increased, with a corresponding decrease in left ventricle systolic function, and an increased atrial activation times, lower effective refractory periods, and increased atrial fibrillation inducibility. This model provides a means to understand the remodeling by which mitral regurgitation causes atrial fibrillation.

  View details for DOI 10.1016/j.jtcvs.2018.05.078

  View details for Web of Science ID 000447417800035

  View details for PubMedID 30336917

  View details for PubMedCentralID PMC6935371

• Long-Term Survival Prediction for Coronary Artery Bypass Grafting: Validation of the ASCERT Model Compared With The Society of Thoracic Surgeons Predicted Risk of Mortality ANNALS OF THORACIC SURGERY Lancaster, T. S., Schill, M. R., Greenberg, J. W., Ruaengsri, C., Schuessler, R. B., Lawton, J. S., Maniar, H. S., Pasque, M. K., Moon, M. R., Damiano, R. J., Melby, S. J. 2018; 105 (5): 1336-1343

  Abstract

  The recently developed American College of Cardiology Foundation-Society of Thoracic Surgeons (STS) Collaboration on the Comparative Effectiveness of Revascularization Strategy (ASCERT) Long-Term Survival Probability Calculator is a valuable addition to existing short-term risk-prediction tools for cardiac surgical procedures but has yet to be externally validated.Institutional data of 654 patients aged 65 years or older undergoing isolated coronary artery bypass grafting between 2005 and 2010 were reviewed. Predicted survival probabilities were calculated using the ASCERT model. Survival data were collected using the Social Security Death Index and institutional medical records. Model calibration and discrimination were assessed for the overall sample and for risk-stratified subgroups based on (1) ASCERT 7-year survival probability and (2) the predicted risk of mortality (PROM) from the STS Short-Term Risk Calculator. Logistic regression analysis was performed to evaluate additional perioperative variables contributing to death.Overall survival was 92.1% (569 of 597) at 1 year and 50.5% (164 of 325) at 7 years. Calibration assessment found no significant differences between predicted and actual survival curves for the overall sample or for the risk-stratified subgroups, whether stratified by predicted 7-year survival or by PROM. Discriminative performance was comparable between the ASCERT and PROM models for 7-year survival prediction (p < 0.001 for both; C-statistic = 0.815 for ASCERT and 0.781 for PROM). Prolonged ventilation, stroke, and hospital length of stay were also predictive of long-term death.The ASCERT survival probability calculator was externally validated for prediction of long-term survival after coronary artery bypass grafting in all risk groups. The widely used STS PROM performed comparably as a predictor of long-term survival. Both tools provide important information for preoperative decision making and patient counseling about potential outcomes after coronary artery bypass grafting.

  View details for DOI 10.1016/j.athoracsur.2017.11.045

  View details for Web of Science ID 000430515700024

  View details for PubMedID 29273200

  View details for PubMedCentralID PMC6935366

• The Cox-maze IV procedure in its second decade: still the gold standard? EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Ruaengsri, C., Schill, M. R., Khiabani, A. J., Schuessler, R. B., Melby, S. J., Damiano, R. J. 2018; 53: 19-25

  Abstract

  Atrial fibrillation (AF) is the most common cardiac arrhythmia and the treatment options include medical treatment and catheter-based or surgical interventions. AF is a major cause of stroke, and its prevalence is increasing. The surgical treatment of AF has been revolutionized over the past 2 decades through surgical innovation and improvements in endoscopic imaging, ablation technology and surgical instrumentation. The Cox-maze (CM) procedure, which was developed by James Cox and introduced clinically in 1987, is a procedure in which multiple incisions are created in both the left and the right atria to eliminate AF while allowing the sinus impulse to reach the atrioventricular node. This procedure became the gold standard for the surgical treatment of AF. Its latest iteration is termed the CM IV and was introduced in 2002. The CM IV replaced the previous cut-and-sew method (CM III) by replacing most of the incisions with a combination of bipolar radiofrequency and cryoablation. The use of ablation technologies, made the CM IV technically easier, faster and more amenable to minimally invasive approaches. The aims of this article are to review the indications and preoperative planning for the CM IV, to describe the operative technique and to review the literature including comparisons of the CM IV with the previous cut-and-sew method. Finally, this review explores future directions for the surgical treatment of patients with AF.

  View details for DOI 10.1093/ejcts/ezx326

  View details for Web of Science ID 000445664900005

  View details for PubMedID 29590383

  View details for PubMedCentralID PMC6018688

• Rhythm control: Surgical Ablation ESC CardioMed Ruaengsri, C., Schill, M. R., Schuessler, R. B., Damiano, Jr, R. J. Oxford University Press. 2018; 3

  View details for DOI 10.1093/med/9780198784906.001.0001

• Minimally invasive Tricuspid valve and AF ablation surgery. In Minimally invasive Mitral valve surgery. Minimally invasive Mitral valve surgery Ruaengsri, C. Nova Science Publishers, Inc.. 2016: 283-311
• Surgical ablation for Atrial fibrillation Practical Cardiac Electrophysiology Henn, M. C., Schill, M. R., Ruaengsri, C., Schuessler, R. B. Jaypee The health sciences publisher. 2016: 415-428
• Surgical Therapies for Atrial Fibrillation The Johns Hopkins Textbook of Cardiothoracic Surgery Ruaengsri, C., Khiabani, A. J., Schuessler, R. B., Damiano, Jr, R. J. McGraw-Hill. 2016; 3