Patrick T. O'Gara, MD, MACC, FAHA, Thoralf M. Sundt, MD, Michael A

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The Cardiothoracic Surgical Trials Network: Implications for clinical practice Patrick T. O'Gara, MD, MACC, FAHA, Thoralf M. Sundt, MD, Michael A. Acker, MD, Tirone E. David, MD, Robert E. Michler, MD, Michael A. Borger, MD, Gorav Ailawadi, MD, Vinod H. Thourani, MD, A. Marc Gillinov, MD, Ralph J. Damiano, MD, Michael J. Mack, MD, Richard Lee, MD, Eric A. Rose, MD, Timothy J. Gardner, MD, Marissa A. Miller, DVM, MPH, Richard D. Weisel, MD, Annetine C. Gelijns, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 154, Issue 6, Pages 1938-1956 (December 2017) DOI: 10.1016/j.jtcvs.2017.08.016 Copyright © 2017 Terms and Conditions

Figure 1 Cumulative failure of mitral valve repair or replacement at 2 years. Failure of the intervention was defined as death, moderate or severe MR as seen on transthoracic echocardiography, or mitral reintervention. MR, Mitral regurgitation. From Goldstein and colleagues.16 Copyright © 2016 Massachusetts Medical Society. Reprinted with permission. http://www.nejm.org/doi/full/10.1056/NEJMoa1512913. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

Figure 2 Persistent more than moderate MR was greater after CABG alone than after CABG and MV repair. Presented at the American College of Cardiology Featured Clinical Research, April 3, 2016. MR, Mitral regurgitation; CABG, coronary artery bypass grafting; MV, mitral valve. From Michler and colleagues.17 The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

Figure 3 Freedom from atrial fibrillation after MVS. Freedom from atrial fibrillation was defined as the absence of the condition at both 6 months and 12 months, as assessed by means of 3-day Holter monitoring. A, Freedom from atrial fibrillation after MVS for all patients with 6- and 12-month Holter data. B, Freedom from atrial fibrillation after MVS for the 106 patients in the MVS + ablation arm. CI, Confidence interval; MVS, mitral valve surgery; PVI, pulmonary vein isolation. From Gillinov and colleagues.24 Copyright © 2015 Massachusetts Medical Society. Reprinted with permission. http://www.nejm.org/doi/full/10.1056/NEJMoa1500528. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

Figure 4 Patients with no atrial fibrillation at 7 days. The figure shows the proportion of patients undergoing cardiac surgery who had a stable heart rhythm without atrial fibrillation during the first week after randomization in the rate-control group and the rhythm-control group. From Gillinov and colleagues.26 Copyright © 2016 Massachusetts Medical Society. Reprinted with permission. http://www.nejm.org/doi/full/10.1056/NEJMoa1602002. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

Cumulative failure of mitral valve repair or replacement at 2 years. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1938-1956DOI: (10.1016/j.jtcvs.2017.08.016) Copyright © 2017 Terms and Conditions