Angsu Chartrungsan - Academia.edu (original) (raw)

Uploads

Papers by Angsu Chartrungsan

Research paper thumbnail of Analgesic Effect and Sleep Quality of Low-Dose Dexmedetomidine in Cardiac Surgical Patients After Ultrafast-Track Extubation: A Randomized Clinical Trial

Journal of cardiothoracic and vascular anesthesia, Jun 1, 2024

Research paper thumbnail of Cost-utility analysis of sutureless and rapid deployment versus conventional aortic valve replacement in patients with moderate to severe aortic stenosis in Thailand

PLOS ONE, Jan 18, 2024

Background Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alterna... more Background Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alternative to conventional aortic valve replacement (CAVR) for aortic stenosis (AS) treatment due to its advantages in reducing surgery time and improving outcomes. This study aimed to assess the cost-utility of SUAVR vs. CAVR treatment for patients with moderate to severe AS in Thailand. Methods A two-part constructed model was used to estimate the lifetime costs and quality-adjusted life years (QALYs) from both societal and healthcare perspectives. Data on short-term mortality, complications, cost, and utility data were obtained from the Thai population. Longterm clinical data were derived from clinical studies. Costs and QALYs were discounted annually at 3% and presented as 2022 values. The incremental cost-effectiveness ratio (ICER) was calculated to determine additional cost per QALY gained. Deterministic and probabilistic sensitivity analyses were performed.

Research paper thumbnail of The Influence of Left Ventricular Dysfunction on The Early and Midterm Outcome in The Patients Undergoing Off Pump Coronary Artery Bypass Grafting Assessed by Propensity Matched Score Analysis

The Heart Surgery Forum, 2022

Background: It still remains unclear the depth of influence of left ventricular dysfunction on th... more Background: It still remains unclear the depth of influence of left ventricular dysfunction on the recovery of patients’ physical conditions in the early and midterm period following off-pump coronary artery bypass grafting (OPCAB). Methods: From April 2011 to May 2018, 851 patients underwent OPCAB in our center. All were grouped into two groups: Those whose ejection fraction (EF) was under 35% were defined as the Low EF group (N = 158) and those who maintained EF over 35% were defined as the Faired EF group (N = 693). Preoperatively, there was significant difference in NYHA class (P < 0.001), CCS class (P = 0.038), level of creatinine (P < 0.001), and rate of establishment of IABP (P < 0.001). Results: Regarding all-cause death in the early postoperative period, low EF was a not a risk factor in patients (P = 0.52) or in the matched cohort (P = 0.398); however, in the midterm, it was a significant risk factor in patients (HR 2.07, P = 0.016) and in the matched cohort (HR 2...

Research paper thumbnail of Global Post-Market Clinical Follow-up of the Treovance Stent-Graft for Endovascular Aneurysm Repair: One-Year Results From the RATIONALE Registry

Journal of Endovascular Therapy, 2018

Purpose: To evaluate the safety and performance of the Treovance stent-graft. Methods: The global... more Purpose: To evaluate the safety and performance of the Treovance stent-graft. Methods: The global, multicenter RATIONALE registry ( ClinicalTrials.gov; identifier NCT03449875) prospectively enrolled 202 patients (mean age 73.0±7.8 years; 187 men) with abdominal aortic aneurysms (AAA) suitable for endovascular aneurysm repair (EVAR) using the Treovance. The composite primary safety endpoint was site-reported all-cause mortality and major morbidity. The primary efficacy outcome was clinical success. Further outcomes evaluated included technical success; stent-graft migration, patency, and integrity; endoleak; and aneurysm size changes. Results: Technical success was 96% (194/202); 8 patients had unresolved type I endoleaks at the end of the procedure. There was no 30-day mortality and 1% major morbidity (1 myocardial infarction and 1 bowel ischemia). Clinical success at 1 year was confirmed in 194 (96%) patients; 6 of 8 patients had new/persistent endoleaks and 2 had aneurysm expansio...

Research paper thumbnail of Successful introduction of off-pump coronary artery bypass grafting in southeastern Asian countries: A single Center's experience in Thailand

Surgery Open Science, 2022

Background Off-pump coronary artery bypass grafting has not been standardized in Southeastern Asi... more Background Off-pump coronary artery bypass grafting has not been standardized in Southeastern Asian countries because it is technically demanding. However, this method could be suitable for economically disadvantaged institutions because it saves cost on the heart–lung machine. We summarized our results to assess the validity of our early introduction of this method. Methods We reviewed the data from 750 patients who underwent off-pump coronary artery bypass grafting at our institution. Before the introduction of off-pump coronary artery bypass grafting, experts from Japan were enlisted to teach our surgeons technicalities of the procedure. The primary outcome was in-hospital mortality, and secondary outcomes included any major adverse cardiac or cerebrovascular event. Results The in-hospital mortality rate was 1.5%. The rates of survival and freedom from major adverse cardiac or cerebrovascular event 3 years after the operation were 92.5% ± 1.8% and 90.7% ± 2.2%, respectively. In the multivariable analysis, the independent risk factors for major adverse cardiac or cerebrovascular event were chronic obstructive pulmonary disease (adjusted hazard ratio = 2.35, 95% confidence interval = 1.35–4.10, P = .003) and renal insufficiency (adjusted hazard ratio = 2.70, 95% confidence interval = 1.52–4.80, P = .001), whereas risk factors for in-hospital death were pump conversion (relative risk = 17.4, 95% confidence interval = 1.63–4.41, P < .001). Conclusion Successful introduction of off-pump coronary artery bypass grafting provided a favorable outcome almost equal to that in high-volume centers in developed countries.

Research paper thumbnail of Comparison of Temporary Interruption of Warfarin Therapy for 3 and 5 days before Surgery in Thailand: A Randomized Controlled Trial

Objective: The ACCP guideline 2008 recommended cessation of warfarin five days before surgery. Ho... more Objective: The ACCP guideline 2008 recommended cessation of warfarin five days before surgery. However, based on the observation of the clinical practice at Siriraj Hospital, we suggested a shorter period of three days before surgery. Prior studies have shown multiple factors had effected warfarin dosage, but few studies have shown factors that influenced normalization of prothrombin time after discontinuation of warfarin. Previous studies have shown the genetics factors, vitamin K epoxide reductase (VKORC1) and cytochrome P450 2C9 (CYP2C9) enzyme conjointly determine the warfarin maintenance dose. We wanted to find out the proper timing of warfarin cessation before surgery and relationhip to genetic factors. Methods: Sixty-eight patients on warfarin were randomized to stop warfarin for three or five days. Blood samples were acquired at three or five days after interruption of warfarin in each group and assayed for INR, VKORC1 and CYP2C9. We started bridging therapy when INR was les...

Research paper thumbnail of Analgesic Effect and Sleep Quality of Low-Dose Dexmedetomidine in Cardiac Surgical Patients After Ultrafast-Track Extubation: A Randomized Clinical Trial

Journal of cardiothoracic and vascular anesthesia, Jun 1, 2024

Research paper thumbnail of Cost-utility analysis of sutureless and rapid deployment versus conventional aortic valve replacement in patients with moderate to severe aortic stenosis in Thailand

PLOS ONE, Jan 18, 2024

Background Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alterna... more Background Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alternative to conventional aortic valve replacement (CAVR) for aortic stenosis (AS) treatment due to its advantages in reducing surgery time and improving outcomes. This study aimed to assess the cost-utility of SUAVR vs. CAVR treatment for patients with moderate to severe AS in Thailand. Methods A two-part constructed model was used to estimate the lifetime costs and quality-adjusted life years (QALYs) from both societal and healthcare perspectives. Data on short-term mortality, complications, cost, and utility data were obtained from the Thai population. Longterm clinical data were derived from clinical studies. Costs and QALYs were discounted annually at 3% and presented as 2022 values. The incremental cost-effectiveness ratio (ICER) was calculated to determine additional cost per QALY gained. Deterministic and probabilistic sensitivity analyses were performed.

Research paper thumbnail of The Influence of Left Ventricular Dysfunction on The Early and Midterm Outcome in The Patients Undergoing Off Pump Coronary Artery Bypass Grafting Assessed by Propensity Matched Score Analysis

The Heart Surgery Forum, 2022

Background: It still remains unclear the depth of influence of left ventricular dysfunction on th... more Background: It still remains unclear the depth of influence of left ventricular dysfunction on the recovery of patients’ physical conditions in the early and midterm period following off-pump coronary artery bypass grafting (OPCAB). Methods: From April 2011 to May 2018, 851 patients underwent OPCAB in our center. All were grouped into two groups: Those whose ejection fraction (EF) was under 35% were defined as the Low EF group (N = 158) and those who maintained EF over 35% were defined as the Faired EF group (N = 693). Preoperatively, there was significant difference in NYHA class (P < 0.001), CCS class (P = 0.038), level of creatinine (P < 0.001), and rate of establishment of IABP (P < 0.001). Results: Regarding all-cause death in the early postoperative period, low EF was a not a risk factor in patients (P = 0.52) or in the matched cohort (P = 0.398); however, in the midterm, it was a significant risk factor in patients (HR 2.07, P = 0.016) and in the matched cohort (HR 2...

Research paper thumbnail of Global Post-Market Clinical Follow-up of the Treovance Stent-Graft for Endovascular Aneurysm Repair: One-Year Results From the RATIONALE Registry

Journal of Endovascular Therapy, 2018

Purpose: To evaluate the safety and performance of the Treovance stent-graft. Methods: The global... more Purpose: To evaluate the safety and performance of the Treovance stent-graft. Methods: The global, multicenter RATIONALE registry ( ClinicalTrials.gov; identifier NCT03449875) prospectively enrolled 202 patients (mean age 73.0±7.8 years; 187 men) with abdominal aortic aneurysms (AAA) suitable for endovascular aneurysm repair (EVAR) using the Treovance. The composite primary safety endpoint was site-reported all-cause mortality and major morbidity. The primary efficacy outcome was clinical success. Further outcomes evaluated included technical success; stent-graft migration, patency, and integrity; endoleak; and aneurysm size changes. Results: Technical success was 96% (194/202); 8 patients had unresolved type I endoleaks at the end of the procedure. There was no 30-day mortality and 1% major morbidity (1 myocardial infarction and 1 bowel ischemia). Clinical success at 1 year was confirmed in 194 (96%) patients; 6 of 8 patients had new/persistent endoleaks and 2 had aneurysm expansio...

Research paper thumbnail of Successful introduction of off-pump coronary artery bypass grafting in southeastern Asian countries: A single Center's experience in Thailand

Surgery Open Science, 2022

Background Off-pump coronary artery bypass grafting has not been standardized in Southeastern Asi... more Background Off-pump coronary artery bypass grafting has not been standardized in Southeastern Asian countries because it is technically demanding. However, this method could be suitable for economically disadvantaged institutions because it saves cost on the heart–lung machine. We summarized our results to assess the validity of our early introduction of this method. Methods We reviewed the data from 750 patients who underwent off-pump coronary artery bypass grafting at our institution. Before the introduction of off-pump coronary artery bypass grafting, experts from Japan were enlisted to teach our surgeons technicalities of the procedure. The primary outcome was in-hospital mortality, and secondary outcomes included any major adverse cardiac or cerebrovascular event. Results The in-hospital mortality rate was 1.5%. The rates of survival and freedom from major adverse cardiac or cerebrovascular event 3 years after the operation were 92.5% ± 1.8% and 90.7% ± 2.2%, respectively. In the multivariable analysis, the independent risk factors for major adverse cardiac or cerebrovascular event were chronic obstructive pulmonary disease (adjusted hazard ratio = 2.35, 95% confidence interval = 1.35–4.10, P = .003) and renal insufficiency (adjusted hazard ratio = 2.70, 95% confidence interval = 1.52–4.80, P = .001), whereas risk factors for in-hospital death were pump conversion (relative risk = 17.4, 95% confidence interval = 1.63–4.41, P < .001). Conclusion Successful introduction of off-pump coronary artery bypass grafting provided a favorable outcome almost equal to that in high-volume centers in developed countries.

Research paper thumbnail of Comparison of Temporary Interruption of Warfarin Therapy for 3 and 5 days before Surgery in Thailand: A Randomized Controlled Trial

Objective: The ACCP guideline 2008 recommended cessation of warfarin five days before surgery. Ho... more Objective: The ACCP guideline 2008 recommended cessation of warfarin five days before surgery. However, based on the observation of the clinical practice at Siriraj Hospital, we suggested a shorter period of three days before surgery. Prior studies have shown multiple factors had effected warfarin dosage, but few studies have shown factors that influenced normalization of prothrombin time after discontinuation of warfarin. Previous studies have shown the genetics factors, vitamin K epoxide reductase (VKORC1) and cytochrome P450 2C9 (CYP2C9) enzyme conjointly determine the warfarin maintenance dose. We wanted to find out the proper timing of warfarin cessation before surgery and relationhip to genetic factors. Methods: Sixty-eight patients on warfarin were randomized to stop warfarin for three or five days. Blood samples were acquired at three or five days after interruption of warfarin in each group and assayed for INR, VKORC1 and CYP2C9. We started bridging therapy when INR was les...