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Coronary Artery Disease: HELP
Articles by Akshat Saxena
Based on 8 articles published since 2008
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Between 2008 and 2019, Akshat Saxena wrote the following 8 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review A systematic review on the quality of life benefits after percutaneous coronary intervention in the elderly. 2014

Shan, Leonard / Saxena, Akshat / McMahon, Ross. ·Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia. ·Cardiology · Pubmed #25116399.

ABSTRACT: AIMS: Percutaneous coronary intervention (PCI) is being increasingly performed on elderly patients with acceptable peri-procedural outcomes and long-term survival. We aim to systematically review the health-related quality of life (HRQOL) following PCI in the elderly which is an important measure of procedural success. METHODS: A systematic review of clinical studies before September 2012 was performed to identify HRQOL in the elderly after PCI. Strict inclusion and exclusion criteria were applied. Quality appraisal of each study was also performed using pre-defined criteria. HRQOL results were synthesised through a narrative review with full tabulation of results of all included studies. RESULTS: Elderly patients have significant improvements in cardiovascular well-being. Early HRQOL appears improved from baseline, but recovery in physical health may be slower than in younger patients. HRQOL is comparable to an age-matched general population and younger patients undergoing PCI. Conservative management is not able to offer the same HRQOL benefits. Coronary artery bypass graft surgery may be superior to PCI in the very elderly. Significant heterogeneity and bias exists. Lack of appropriate data precluded meta-analysis. CONCLUSION: HRQOL after PCI in the elderly can improve for at least 1 year across a broad range of health domains, and is comparable to an age-matched general population and younger patients undergoing PCI. Given a limited number of articles and patients included, more prospective studies are needed to better identify the benefits for elderly patients.

2 Review Coronary artery bypass graft surgery in the elderly: a review of postoperative quality of life. 2013

Shan, Leonard / Saxena, Akshat / McMahon, Ross / Newcomb, Andrew. ·Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria (L.S., A.S., A.N.) · Cardiology Unit, South Eastern Sydney and Illawarra Health Network, Wollongong, NSW (A.S., R.M.) · and University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (A.N.). ·Circulation · Pubmed #24249619.

ABSTRACT: -- No abstract --

3 Article A propensity-score matched analysis on the impact of postoperative atrial fibrillation on the early and late outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery. 2014

Saxena, Akshat / Shi, William Y / Paramanathan, Ashvin / Herle, Pradyumna / Dinh, Diem / Smith, Julian A / Reid, Christopher M / Shardey, Gilbert / Newcomb, Andrew E. ·aDepartment of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy bMelbourne Medical School, University of Melbourne, Melbourne cDepartment of Epidemiology and Preventive Medicine, Monash University, Prahran dDepartment of Surgery (MMC), Monash University and Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton eCabrini Medical Centre, Malvern fUniversity of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. ·J Cardiovasc Med (Hagerstown) · Pubmed #24572338.

ABSTRACT: BACKGROUND: Postoperative atrial fibrillation (POAF) is a known complication of cardiac surgery. There is a paucity of data on the effects of POAF on short-term and long-term outcomes after concomitant aortic valve replacement and coronary artery bypass grafting (AVR-CABG ). METHODS: We retrospectively reviewed data on patients without preexisting arrhythmia who underwent isolated first-time AVR-CABG between June 2001 and December 2009 using the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program. Preoperative characteristics, early postoperative outcomes and late survival were compared between patients who developed POAF and those who did not. Propensity score matching was performed to account for the differences between the two groups. RESULTS: Isolated AVR-CABG surgery was performed in 2028 patients without preexisting arrhythmias at 18 Australian institutions, of whom 894 (44.1%) developed POAF. POAF patients were generally older (mean age, 75 vs. 73 years, P < 0.001). From the initial study population, 715 propensity-matched patient-pairs were derived; the overall matching rate was 80.0%. In the matched groups, 30-day mortality was similar in both groups (3.5 vs. 2.1%, P = 0.16). Patients with POAF, however, were more likely to develop perioperative complications, including new renal failure, prolonged ventilation (>24 h), multisystem failure and readmission within 30 days of surgery (all P < 0.05). Patients with POAF also had a significantly greater length of hospital stay (P < 0.001). Seven-year survival was not significantly different between the two groups (72 vs. 75%, P = 0.11). CONCLUSION: POAF was not associated with an increased risk of early or late mortality. It is, however, associated with poorer perioperative outcomes. It is important to evaluate potential treatment strategies for POAF.

4 Article Impact of smoking status on outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery. 2014

Saxena, Akshat / Shan, Leonard / Dinh, Diem T / Reid, Christopher M / Smith, Julian A / Shardey, Gilbert C / Newcomb, Andrew E. ·Department of Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia. · Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. · Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia. · Department of Surgery (MMC), Monash University and Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia. · Cabrini Medical Centre, Malvern, Victoria, Australia. ·Thorac Cardiovasc Surg · Pubmed #24163261.

ABSTRACT: BACKGROUND: There is a paucity of data on the impact of smoking status on outcomes after concomitant aortic valve replacement and coronary artery bypass graft (AVR-CABG) surgery. METHODS: Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who were nonsmokers, previous smokers, and current smokers using chi-square test and t-test. The independent impact of smoking status on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively. RESULTS: Concomitant AVR-CABG surgery was performed in 2,563 patients; smoking status was recorded in 2,558 (99.8%) patients. Of these, 1,052 (41.1%) patients had no previous smoking history, 1,345 (52.6%) patients were previous smokers, and 161 (6.3%) patients were current smokers. The 30-day mortality rate was 3.5% in nonsmokers, 4.1% in previous smokers, and 3.1% in current smokers (p = nonsignificant). The incidence of perioperative complications was similar in the three groups. The mean follow-up period for this study was 36 months (range, 0-105 months). After adjusting for differences in patient variables, the incidence of late mortality was higher in previous smokers (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14-1.81; p = 0.002) compared with nonsmokers. A trend toward increased late mortality in current smokers was noted (HR, 1.34; 95% CI, 0.86-2.08; p = 0.201). CONCLUSION: Smoking is not associated with adverse outcomes after concomitant AVR-CABG surgery. Smoking status should not, therefore, preclude these patients from undergoing this procedure. Given the adverse effect of smoking on overall cardiovascular morbidity and mortality and late postoperative mortality, patients should be encouraged to quit smoking.

5 Article Impact of left ventricular dysfunction on early and late outcomes in patients undergoing concomitant aortic valve replacement and coronary artery bypass graft surgery. 2013

Saxena, Akshat / Paramanathan, Ashvin / Shi, William Y / Dinh, Diem T / Reid, Christopher M / Smith, Julian A / Shardey, Gilbert C / Newcomb, Andrew E. ·Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. andrew.newcomb@svhm.org.au. ·Cardiol J · Pubmed #23913462.

ABSTRACT: BACKGROUND: An increasing proportion of patients present for concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) with left ventricular (LV) dysfunction. The aim of this study was to evaluate the early outcomes and late survival of patients with different degrees of LV function undergoing concomitant AVR and CABG. METHODS: Between June 2001 and December 2009, patients undergoing concomitant AVR-CABG were identified from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program. Demographic, operative data and post-operative outcomes were compared between patients with normal (> 60%), moderately impaired (30- -60%), and severely impaired (< 30%) estimated LV ejection fraction (LVEF). Independent risk factors for short- and long-term mortality were identified using binary logistic and Cox regression, respectively. RESULTS: AVR-CABG was performed in 2,563 patients with a mean follow up of 36 months (range 0-106). 144 (5.6%) had severely impaired LVEF, 983 (38.3%) had moderately impaired LVEF while the remaining 1377 (53.7%) had normal LVEF. The 30-day mortality in patients with severely impaired, moderately impaired and normal LVEF was 9.0%, 4.3% and 2.9%, respectively. This was significant on univariate (p < 0.001) but not multivariate analysis (p = NS). Severely impaired, moderately impaired and normal LVEF patients experienced 5-year survivals of 63.7%, 77.1% and 82.5%, respectively. Severely impaired LVEF was an independent multivariable predictor of late mortality (HR 1.71; 95% CI 1.22-2.40; p = 0.002). CONCLUSIONS: Patients with severely impaired LVEF experience worse outcomes. However, in the era of modern surgery, this alone should not predicate exclusion, given the established benefits of surgery in this high-risk group.

6 Article Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery. 2013

Saxena, Akshat / Dinh, Diem / Dimitriou, Jim / Reid, Christopher / Smith, Julian / Shardey, Gilbert / Newcomb, Andrew. ·Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia. ·Interact Cardiovasc Thorac Surg · Pubmed #23287590.

ABSTRACT: OBJECTIVES: Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery. METHODS: Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively. RESULTS: Concomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14-2.19; P = 0.006). CONCLUSIONS: PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure.

7 Article Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients). 2012

Saxena, Akshat / Dinh, Diem T / Smith, Julian A / Shardey, Gilbert C / Reid, Christopher M / Newcomb, Andrew E. ·Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. a.saxena@student.unimelb.edu.au ·Am J Cardiol · Pubmed #22011556.

ABSTRACT: Several studies have shown that postoperative atrial fibrillation (POAF) is associated with poorer short- and long-term outcomes after isolated coronary artery bypass grafting surgery. Nevertheless, there is considerable debate as to whether this reflects an independent association of POAF with poorer outcomes or confounding by other factors. We sought to investigate this issue. Data obtained from June 2001 through December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who developed POAF and those who did not using chi-square and t tests. The independent impact of POAF on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively. Excluding patients with preoperative arrhythmia, isolated coronary artery bypass grafting surgery was performed in 19,497 patients. Of these, 5,547 (28.5%) developed POAF. Patients with POAF were generally older (mean age 69 vs 65 years, p <0.001) and presented more often with co-morbidities including congestive heart failure (p <0.001), hypertension (p <0.001), cerebrovascular disease (p <0.001), and renal failure (p = 0.046). Patients with POAF demonstrated a greater 30-day mortality on univariate analysis but not on multivariate analysis (p = 0.376). Patients with POAF were, however, at an independently increased risk of perioperative complications including permanent stroke (p <0.001), new renal failure (p <0.001), infective complications (p <0.001), gastrointestinal complications (p <0.001), and return to the theater (p <0.001). POAF was also independently associated with shorter long-term survival (p = 0.002). In conclusion, POAF is a risk factor for short-term morbidity and decreased long-term survival. Rigorous evaluation of various therapies that prevent or decrease the impact of POAF is imperative. Moreover, patients who develop POAF should undergo strict surveillance and be routinely screened for complications after discharge.

8 Minor Analysis of early and late outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery in octogenarians: a multi-institutional Australian study. 2011

Saxena, Akshat / Dinh, Diem / Poh, Chin-Leng / Smith, Julian A / Shardey, Gilbert / Newcomb, Andrew E. · ·J Am Geriatr Soc · Pubmed #22136542.

ABSTRACT: -- No abstract --