Marc Ruel's research while affiliated with University of Ottawa and other places

Publications (434)

Article
Importance: In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limite...
Article
Importance: The role of ticagrelor with or without aspirin after coronary artery bypass graft surgery remains unclear. Objective: To compare the risks of vein graft failure and bleeding associated with ticagrelor dual antiplatelet therapy (DAPT) or ticagrelor monotherapy vs aspirin among patients undergoing coronary artery bypass graft surgery....
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Methylglyoxal (MG) production after myocardial infarction (MI) leads to advanced glycation end‐product formation, adverse remodeling, and loss of cardiac function. The extracellular matrix (ECM) is a main target for MG glycation. This suggests that ECM‐mimicking biomaterial therapies may protect the post‐MI environment by removing MG. In this study...
Article
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is compl...
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Background: Compared to conventional aspirin therapy, ticagrelor did not improve vein graft patency 1 year after coronary bypass surgery (CABG) in the ticagrelor antiplatelet therapy to reduce graft events and thrombosis (TARGET) trial. However, it is unknown whether ticagrelor may impact graft patency long-term following surgery. Methods: In th...
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Cardiomyocytes are the muscle cells that make the heart beat, pump oxygen, and deliver nutrient-rich blood throughout the human body. During a heart attack, the blood supply to the heart is interrupted. Cardiomyocytes then die and are replaced by scar tissue that can no longer contract. As a result, the heart is weakened and may beat abnormally. Fo...
Article
The utilization of bioprostheses for surgical heart valve replacement has been increasing across all age groups. For patients, the appeal of the bioprosthetic valve rests with the avoidance of anticoagulation, fewer thrombotic and hemorrhagic events, and the increasing availability of transcatheter valve-in-valve interventions -both in the aortic a...
Article
Objectives It is unclear whether coronary artery bypass grafting (CABG) improves survival compared to medical therapy (MT) in patients with stable coronary artery disease (CAD). The aim of this analysis was to perform an individual patient data pooled meta-analysis of contemporary randomized controlled trials (RCTs) that compared CABG and MT in pat...
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Introduction There is emerging evidence supporting the use of the radial artery (RA) as a preferred secondary conduit for coronary artery bypass grafting (CABG) as it is associated with higher rates of graft patency at 5 years when compared with saphenous vein grafts (SVG). The modified Allen’s test (MAT) is traditionally regarded as the standard o...
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Right ventricular failure (RVF) is a significant cause of mortality and morbidity after cardiac surgery. Despite its prognostic importance, RVF remains under investigated and without a universally accepted definition in the perioperative setting. We foresee that the provision of a standardized perioperative definition for RVF based on practical and...
Article
Background: Surgical delay may result in unintended harm to patients needing cardiac surgery, who are at risk for death if their condition is left untreated. Our objective was to derive and internally validate a clinical risk score to predict death among patients awaiting major cardiac surgery. Methods: We used the CorHealth Ontario Registry and...
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Background Antiplatelet therapy prevents saphenous vein graft (SVG) occlusion and improves outcomes after coronary artery bypass graft surgery (CABG). However, the optimal postoperative antiplatelet regimen remains unclear. The goal of the Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET) trial was to assess whether ear...
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We report the development, as well as the in vitro and in vivo testing, of a sprayable nanotherapeutic that uses surface engineered custom-designed multiarmed peptide grafted nanogold for on-the-spot coating of an infarcted myocardial surface. When applied to mouse hearts, 1 week after infarction, the spray-on treatment resulted in an increase in c...
Article
Background: Current guidelines recommend a target international normalized ratio (INR) range of 2.5 to 3.5 in patients with a mechanical mitral prosthesis. The Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) Mitral randomized controlled trial assessed the safety and efficacy of warfarin at doses lower than currently recommended...
Article
Young and low-risk patients with aortic stenosis pose a clinical dilemma. The need for life-long anticoagulation with mechanical prostheses, the risk of early degeneration of stented and stentless bioprostheses, the unknown long-term outcomes of transcatheter valve implantation and the high surgical risk of a Ross procedure all have long-term impli...
Article
BACKGROUND Implantation of a bioprosthetic valve is a reasonable choice for patients aged >65 years. For middle-aged patients, there is less certainty about whether a mechanical or bioprosthetic valve is best. METHODS The PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial is evaluating the safety and efficacy of the Avalus biopr...
Article
Background The relationship between institutional volume and operative mortality following SAVR remains unclear. Methods From 1/2013 to 6/2018, 234,556 patients underwent isolated SAVR (n=144,177) or SAVR+CABG (n=90,379) within the STS ACSD. The association between annualized SAVR volume [Group 1 (1-25 SAVR), Group 2 (26-50 SAVR), Group 3 (51-100...
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Transit time flow measurement (TTFM) allows quality control in coronary artery bypass grafting but remains largely underused, probably because of limited information and the lack of standardization. We performed a systematic review of the evidence on TTFM and other methods for quality control in coronary artery bypass grafting following PRISMA stan...
Article
Background: Wnt signaling plays a critical role in both embryonic cardiogenesis and cardiac remodeling in adult heart disease. We have previously demonstrated that the canonical Wnt/β-catenin pathway inhibits cardiac sodium current, but it remains unclear whether the noncanonical Wnt pathway affects cardiac electrophysiology. Methods and Results: W...
Article
Objectives: The aim of this study was to evaluate clinical characteristics, mechanisms of failure, and outcomes of transcatheter aortic valve replacement (TAVR) explantation. Background: Surgical explantation following TAVR may be required for structural valve degeneration, paravalvular leak, infection, or other reasons. However, in-depth data o...
Article
Background: Aortic valve repair(AVr) has emerged as a feasible and effective alternative to replacement(AVR) in patients with aortic insufficiency(AI), however, little data exists comparing outcomes. Thus, the objective of this study was to compare early and long-term valve related complications between AVr and AVR in the treatment of AI. Methods...
Article
It is now widely recognized that COVID-19 illness can be associated with significant intermediate and potentially longer-term physical limitations. The term “Long COVID-19” is used to define any patient with persistent symptoms after acute COVID-19 (i.e. after 4 weeks). It is postulated that cardiac injury may be linked to symptoms that persist fol...
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Background We compared early outcomes, at a single academic institution, of implementing full coronary revascularization in coronary artery bypass grafting using multiarterial Y‐composite grafts with multiple sequential anastomoses. Methods and Results Clinical records of 425 consecutive patients who underwent coronary artery bypass grafting using...
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Outflow tract abnormalities are the most frequent congenital heart defects. These are due to the absence or dysfunction of the two main cell types, i.e., neural crest cells and secondary heart field cells that migrate in opposite directions at the same stage of development. These cells directly govern aortic arch patterning and development, ascendi...
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Importance There is little evidence to support patient-centered outcomes in patients with cardiovascular disease. Objective To derive patient-defined adverse cardiovascular and noncardiovascular events (PACE) through a consensus-based process. Design, Setting, and Participants This pan-Canadian, consensus-based, qualitative study used an iterativ...
Chapter
Minimally invasive cardiac surgery (MICS) has emerged as a safe alternative to standard cardiac surgery. The technique for minimally invasive coronary artery bypass grafting (MICS CABG) has evolved over the years, and in addition to multivessel revascularization, bilaterally internal thoracic artery take down is currently feasible to allow for mult...
Article
Hospitals and ambulatory facilities significantly reduced cardiac care delivery in response to the first wave of the COVID-19 pandemic. The deferral of elective cardiovascular procedures led to a marked reduction in healthcare delivery with a significant impact on optimal cardiovascular care. International and Canadian data have reported dramatical...
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Background: High-dose atorvastatin did not improve 1-year vein graft patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft Events trial. However, it remains unknown whether high-intensity statins may impact graft disease in the years that follow. Methods: In the trial, patients (N = 173) were randomized to receive atorvastat...
Conference Paper
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BACKGROUND Patients with a history of percutaneous coronary intervention (PCI) are at increased risk for ischemic events despite statin therapy. METHODS In a multicenter, double-blind, placebo-controlled trial, statin-treated patients with triglycerides of 135 to 499 mg/dl, controlled low-density lipoprotein (41 to 100 mg/dl), and either establishe...
Article
In Reply We thank JAMA Cardiology for the opportunity to respond to the comments provided by Cheney and Hira. We appreciate their interest in our article.
Article
Importance Mortality is a common outcome in trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG). Controversy exists regarding whether all-cause mortality or cardiac mortality is preferred as a study end point, because noncardiac mortality should be unrelated to the treatment. Objective To evaluate...
Article
Background: Equipoise exists between the use of leaflet resection and preservation for surgical repair of mitral regurgitation caused by prolapse. We therefore performed a randomized, controlled trial comparing these 2 techniques, particularly in regard to functional mitral stenosis. Methods: One hundred four patients with degenerative mitral re...
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Background and Aim To evaluate the publication rate of articles related to cardiac surgery in the four main cardiovascular journals over the last 5 years. Methods A bibliometric review of all full‐length articles published between January 2014 and March 2020 in the top four cardiovascular journals (Circulation, European Heart Journal (EHJ), Journa...
Article
Background Across the globe, elective surgeries have been postponed to limit infectious exposure and preserve hospital capacity for coronavirus disease 2019 (COVID‐19). However, the ramp down in cardiac surgery volumes may result in unintended harm to patients who are at high risk of mortality if their conditions are left untreated. To help optimiz...
Article
Purpose of review: The aim of this review is to review the current literature on the management of stable ischemic heart disease in light of findings from the International Study of Comparative Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial. Recent findings: Compared with optimal medical therapy, coronary artery bypass graft...
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Background Pigs/bovines share common antigens with humans: α‐Gal, present in all pigs/bovines close to the human B‐antigen; and AH‐histo‐blood‐group antigen, identical to human AH‐antigen and present only in some animals. We investigate the possible impact of patients’ ABO blood group on bioprosthesis structural valve degeneration (SVD) through cal...
Article
Background Current data on cardiac surgical practices for people living with human immunodeficiency virus (HIV) are lacking. We hypothesized that cardiac surgeons would consider people living with HIV as candidates for the full scope of cardiac surgery including heart transplant for these patients. Methods We conducted a prospective survey of 155...
Article
Objective: To compare the long-term outcomes of MAR versus SAR in patients with renal insufficiency. Summary of background data: Previous studies have been insufficiently powered to address whether MAR confers long-term benefit over SAR in patients with renal dysfunction who require CABG. Methods: We conducted retrospective cohort study in Ont...
Article
Injectable hydrogels are a promising method to enhance repair in the heart after myocardial infarction (MI). However, few studies have compared different strategies for the application of biomaterial treatments. In this study, we use a clinically relevant mouse MI model to assess the therapeutic efficacy of different treatment protocols for intramy...
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Importance Changes in evidence-based practice and guideline recommendations depend on high-quality randomized clinical trials (RCTs). Commercial device and pharmaceutical manufacturers are frequently involved in the funding, design, conduct, and reporting of trials, the implications of which have not been recently analyzed. Objective To evaluate t...
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The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit towards one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework t...
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Background Contradictory findings from randomized trials addressing similar research questions are not uncommon in medicine. While differing results may reflect true differences in the treatment effects or in the deliverability of the intervention, more commonly it is as a consequence of small but important discrepancies in study design. Methods T...
Article
Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compare...
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Background Vitamin K antagonists are the only approved oral anticoagulants for long-term prophylaxis against valve thrombosis and thromboembolism in patients with a mechanical heart valve. Despite the proven efficacy and safety of anticoagulation with the oral direct factor Xa inhibitor, apixaban compared with warfarin in high-risk populations incl...