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Munir MB, Jiang J, Mehdi MJ, Takayama H, Cheema FH. A novel subcutaneous counterpulsation device: acute hemodynamic efficacy during pharmacologically induced hypertension, hypotension, and heart failure. Artif Organs 2011; 35:92-3; author reply 93-5. [PMID: 21226745 DOI: 10.1111/j.1525-1594.2010.01176.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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77
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Bisleri G, Cheema FH, Muneretto C. Sternal oozing following cardiac surgery: unusual presentations of left ventricular patch dehiscence. J Card Surg 2010; 26:71. [PMID: 21044151 DOI: 10.1111/j.1540-8191.2010.01137.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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78
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Iribarne A, Russo MJ, Easterwood R, Hong KN, Yang J, Cheema FH, Smith CR, Argenziano M. Minimally Invasive Versus Sternotomy Approach for Mitral Valve Surgery: A Propensity Analysis. Ann Thorac Surg 2010; 90:1471-7; discussion 1477-8. [DOI: 10.1016/j.athoracsur.2010.06.034] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 06/03/2010] [Accepted: 06/07/2010] [Indexed: 10/18/2022]
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79
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Pak SW, Cappleman S, Schaefle KJ, Cheema FH, George G, Takayama H, Naka Y, Mancini D, Schulze CP, Farr M. Abnormal Thyroid Function in Patients With Advanced Heart Failure Reverses after Heart Transplantation. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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80
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Ahmad M, Topkara VK, Housman B, Argenziano M, Cheema FH. Assessment of a new experimental model of isolated right ventricular failure. Artif Organs 2010; 34:269-70; author reply 270-1. [PMID: 20447053 DOI: 10.1111/j.1525-1594.2010.00999.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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81
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Munir MB, Schaefle KJ, Argenziano M, Cheema FH. Letter to the editor Re: First clinical application of the DuraHeart centrifugal ventricular assist device for a Japanese patient. Artif Organs 2010; 34:348. [PMID: 20420618 DOI: 10.1111/j.1525-1594.2010.01010.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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82
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Cheema FH, Pervez MB, Roberts HG. OP-040 INITIAL EXPERIENCE OF CONCOMITANT COX-CRYOMAZE WITH MITRAL VALVULOPLASTY USING A ROBOTIC ENDOSCOPIC APPROACH. Int J Cardiol 2010. [DOI: 10.1016/s0167-5273(10)70042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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83
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Cheema FH, Kanwal S, Pervez MB, Roberts HG. OP-077 THE INCREASED BURDEN OF PACEMAKERS IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING SURGICAL ABLATION USING A COX-CRYOMAZE APPROACH: IS IT AN ACCEPTABLE TRADE-OFF? Int J Cardiol 2010. [DOI: 10.1016/s0167-5273(10)70078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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84
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Agrifoglio M, Barili F, Dainese L, Cappai A, Cheema FH, Biglioli P. An occasional diagnosis of myasthenia gravis--a focus on thymus during cardiac surgery: a case report. J Cardiothorac Surg 2009; 4:55. [PMID: 19811646 PMCID: PMC2764702 DOI: 10.1186/1749-8090-4-55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 10/07/2009] [Indexed: 12/02/2022] Open
Abstract
Background Myasthenia gravis, an uncommon autoimmune syndrome, is commonly associated with thymus abnormalities. Thymomatous myasthenia gravis is considered to have worst prognosis and thymectomy can reverse symptoms if precociously performed. Case report We describe a case of a patient who underwent mitral valve repair and was found to have an occasional thymomatous mass during the surgery. A total thymectomy was performed concomitantly to the mitral valve repair. Conclusion The diagnosis of thymomatous myasthenia gravis was confirmed postoperatively. Following the surgery this patient was strictly monitored and at 1-year follow-up a complete stable remission had been successfully achieved.
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Oliver JA, Klinakis A, Cheema FH, Friedlander J, Sampogna RV, Martens TP, Liu C, Efstratiadis A, Al-Awqati Q. Proliferation and migration of label-retaining cells of the kidney papilla. J Am Soc Nephrol 2009; 20:2315-27. [PMID: 19762493 DOI: 10.1681/asn.2008111203] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The kidney papilla contains a population of cells with several characteristics of adult stem cells, including the retention of proliferation markers during long chase periods (i.e., they are label-retaining cells [LRCs]). To determine whether the papillary LRCs generate new cells in the normal adult kidney, we examined cell proliferation throughout the kidney and found that the upper papilla is a site of enhanced cell cycling. Using genetically modified mice that conditionally expressed green fluorescence protein fused to histone 2B, we observed that the LRCs of the papilla proliferated only in its upper part, where they associate with "chains" of cycling cells. The papillary LRCs decreased in number with age, suggesting that the cells migrated to the upper papilla before entering the cell cycle. To test this directly, we marked papillary cells with vital dyes in vivo and found that some cells in the kidney papilla, including LRCs, migrated toward other parts of the kidney. Acute kidney injury enhanced both cell migration and proliferation. These results suggest that during normal homeostasis, LRCs of the kidney papilla (or their immediate progeny) migrate to the upper papilla and form a compartment of rapidly proliferating cells, which may play a role in repair after ischemic injury.
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Barili F, Dainese L, Cheema FH, Argenziano M, Locatelli A, Grossi C. Bioengineering of the aortic valve: a race without a finish line. Artif Organs 2009; 33:86-7. [PMID: 19178447 DOI: 10.1111/j.1525-1594.2008.00679.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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87
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Cheema FH, Weisberg JS, Khalid I, Roberts HG. Warm Beating Heart, Robotic Endoscopic Cox-Cryomaze: An Approach for Treating Atrial Fibrillation. Ann Thorac Surg 2009; 87:966-8. [PMID: 19231444 DOI: 10.1016/j.athoracsur.2008.07.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/14/2008] [Accepted: 07/16/2008] [Indexed: 11/17/2022]
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88
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Kanwal S, Malik N, Singh J, Khalid I, Cheema FH. Re: Hydrogel-based engineered skeletal muscle grafts normalize heart function early after myocardial infarction. Artif Organs 2009; 33:87; author reply 87-8. [PMID: 19178449 DOI: 10.1111/j.1525-1594.2008.00680.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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89
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Kanwal S, Malik NM, Cheema FH. Innovative, replaceable heart valve: concept, in vitro study, and acute in vivo study. Artif Organs 2009; 32:999; author reply 999-1000. [PMID: 19133033 DOI: 10.1111/j.1525-1594.2008.00662.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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90
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Osorio JC, Cheema FH, Martens TP, Mahmut N, Kinnear C, Gonzalez AMD, Bonney W, Homma S, Liao JK, Mital S. Simvastatin reverses cardiac hypertrophy caused by disruption of the bradykinin 2 receptor. Can J Physiol Pharmacol 2008; 86:633-42. [PMID: 18758513 DOI: 10.1139/y08-068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bradykinin 2 receptor (B2R) deficiency predisposes to cardiac hypertrophy and hypertension. The pathways mediating these effects are not known. Two-month-old B2R knockout (KO) and wild-type (WT) mice were assigned to 4 treatment groups (n = 12-14/group): control (vehicle); nitro-L-arginine methyl ester (L-NAME) an NO synthase inhibitor; simvastatin (SIM), an NO synthase activator; and SIM+L-NAME. Serial echocardiography was performed and blood pressure (BP) at 6 weeks was recorded using a micromanometer. Myocardial eNOS and mitogen-activated protein kinase (MAPK, including ERK, p38, and JNK) protein expression were measured. Results showed that (i) B2RKO mice had significantly lower ejection fraction than did WT mice (61% +/- 1% vs. 73% +/- 1%), lower myocardial eNOS and phospho-eNOS, normal systolic BP, and higher LV mass, phospho-p38, and JNK; (ii) L-NAME increased systolic BP in KO mice (117 +/- 19 mm Hg) but not in WT mice and exacerbated LV hypertrophy and dysfunction; and (iii) in KO mice, SIM decreased hypertrophy, p38, and JNK, improved function, increased capillary eNOS and phospho-eNOS, and prevented L-NAME-induced LV hypertrophy without lowering BP. We conclude that disruption of the B2R causes maladaptive cardiac hypertrophy with myocardial eNOS downregulation and MAPK upregulation. SIM reverses these abnormalities and prevents the development of primary cardiac hypertrophy as well as hypertrophy secondary to L-NAME-induced hypertension.
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91
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Cayci C, Russo M, Cheema FH, Cheema F, Martens T, Ozcan V, Argenziano M, Oz MC, Ascherman J. Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Ann Plast Surg 2008; 61:294-301. [PMID: 18724131 DOI: 10.1097/sap.0b013e31815acb6a] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objectives of this study are to determine risk factors associated with deep sternal wound infections (DSWIs) following cardiac surgery, and to describe their impact on long-term survival. Data was obtained from a departmental database. Analysis included 7,978 consecutive patients who underwent cardiac surgery between 1997 and 2003. To identify risk factors for DSWI, regression analysis was performed. The probability scores obtained from logistic regression were used for propensity analysis of 2 groups. Kaplan-Meier analysis with log-rank test and Cox proportional hazard models were then used in survival analysis. DSWI developed in 123 of 7,978 patients (1.5%). Preoperative predictors of DSWI were body mass index >30 kg/m(2) (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1 to 2.4; P < 0.05), diabetes mellitus (OR, 2.4; 95% CI, 1.6 to 3.4; P < 0.001), urgent operation (OR, 1.7; 95% CI, 1.2 to 2.6; P < 0.05), smoking history within past year (OR, 2.7; 95% CI, 1.5 to 4.9; P < 0.001), smoking history within past 2 weeks (OR, 2.6; 95% CI, 1.5 to 4.5; P < 0.001), and a history of stroke (OR, 1.9; 95% CI, 1.1 to 3.1; P < 0.005). In addition, total length of hospital stay (OR, 1.01; 95% CI, 1.01 to 1.02; P < 0.05) and sepsis and/or endocarditis following surgery (OR, 5.1; 95% CI, 2.9 to 9.0; P < 0.001) were also predictive of DSWI. Patients with DSWI had a prolonged total length of hospital stay (40.3 days versus 16.1 days; P < 0.001), and higher 30-day mortality (1.6% versus 7.3% in DSWI group, P < 0.05). There were no differences between groups in 4-year and 8-year survival rates, with 77.2% and 61.8%, respectively, in patients with DSWI compared with 78.0% and 67.5% in patients without DSWI (P = 0.16). After adjustments for preoperative, intraoperative, and postoperative factors, the adjusted hazard ratio of long-term mortality for patients with DSWI was 0.9 (95% CI, 0.6 to 1.2, P = 0.39). Though DSWIs are associated with increased early mortality, patients undergoing cardiac surgery complicated by DSWI do not experience worse long-term survival.
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92
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Morgan JA, Naseem TM, Cheema FH, Mignatti A, Scripps T, Sayer G, Tabata M, Argenziano M, Leitz K, Naka Y, Jorde UP. Implantation of Biventricular Circulatory Support with the Levitronix CentriMag in Patients with Acute ST-Elevation Myocardial Infarction (STEMI) and Refractory Cardiogenic Shock. J Card Fail 2008. [DOI: 10.1016/j.cardfail.2008.06.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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93
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Imren Y, Tasoglu I, Oktar GL, Benson A, Naseem T, Cheema FH, Cheema F, Unal Y. The importance of transesophageal echocardiography in diagnosis of pericardial tamponade after cardiac surgery. J Card Surg 2008; 23:450-3. [PMID: 18462344 DOI: 10.1111/j.1540-8191.2008.00581.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Despite the fact that there is a simple and effective treatment for pericardial tamponade (PCT), delayed diagnosis can cause serious morbidities or even mortality. In this study, we discuss the management and the diagnostic procedures of PCT. MATERIALS AND METHODS Sixty-two patients with suspected PCT were initially evaluated with transthoracic echocardiography (TTE) and then with transesophageal echocardiography (TEE). Forty-nine (79%) patients were chosen for surgery after TEE displayed a suspected PCT diagnosis. Patients with suspected PCT were divided into two groups: Early-phase PCT (symptoms developed within 72 hours) and late-phase PCT (symptoms developed after 72 hours). RESULTS Thirty-five (56%) patients were in the early phase and 27 (44%) patients were in the late phase. In 13 out of 22 (59%) cases, from both early and late phases, TTE findings showed no PCT, but TEE findings showed a positive PCT diagnosis. All 13 of the cases where TEE was positive after a negative TTE were confirmed by surgery. Overall, the PCT diagnoses in 48 out of 49 patients were confirmed during surgery. DISCUSSION The role of echocardiography in PCT diagnosis is shown to be extremely important in some clinical cases, such as in patients during the postoperative period after cardiac surgery. Furthermore, particularly when TTE does not provide complete imaging of the pericardial sac, TEE should be mandatory. We recommend that even patients with a negative diagnosis of PCT from TTE should undergo further evaluation with TEE.
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Imren Y, Benson AA, Oktar GL, Cheema FH, Comas G, Naseem T. Is use of temporary pacing wires following coronary bypass surgery really necessary? THE JOURNAL OF CARDIOVASCULAR SURGERY 2008; 49:261-267. [PMID: 18431348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM Temporary epicardial pacing wires (TEPW) which are routinely used after coronary bypass grafting may result in significant complications. We sought to identify variables that predict TEPW implantation and thereby limit their use. METHODS This prospective study enrolled 564 patients (296 underwent coronary artery bypass grafting with cardiopulmonary bypass [ONCAB] and 268 underwent off-pump coronary artery bypass grafting, OPCAB). TEPW were placed in patients with the intraoperative presence of one or more of the following criteria: sinus bradycardia, sinus arrest, nodal/junctional rhythms, atrioventricular block, bundle branch block, ventricular tachycardia, or onset of atrial fibrillation. RESULTS Only 31 (5.5%) patients [ONCAB: 20 (6.8%) (ventricular: 14, bichamber: 6); OPCAB: 11 (4.1%) (ventricular: 9, bichamber: 2)] had temporary epicardial pacing wires implanted intraoperatively. Indications for using temporary epicardial pacing wires for ONCAB were sinus bradycardia (8), nodal/junctional rhythms (3), atrioventricular block (3), atrial fibrillation (4), and bundle branch block (2), and for OPCAB were sinus bradycardia (8), nodal/junctional rhythms (2), and atrioventricular block (1). Mean duration for pacing was 22.4 h for the ONCAB group and 11.3 h for the OPCAB group. There were no temporary epicardial pacing wires associated complications. One paced OPCAB patient required a permanent pacemaker and 2 non-paced OPCAB patients required transvenous pacing wires. Univariate and multivariate analyses were also conducted to determine risk factors for TEPW. CONCLUSION TEPW implantation is overused in cardiac surgery and by identifying independent predictors for pacing we conclude that TEPW use should be limited to a select few.
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Topkara VK, Williams MR, Cheema FH, Vigilance DW, Garrido MJ, Russo MJ, Oz MC, Argenziano M. Surgical ablation of atrial fibrillation: the Columbia Presbyterian experience. J Card Surg 2007; 21:441-8. [PMID: 16948752 DOI: 10.1111/j.1540-8191.2006.00273.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Maze III procedure is an effective surgical treatment for atrial fibrillation (AF). However, it is not widely applied due to its complexity, increased operative times, and the risk of bleeding. Various energy sources have been introduced to simplify the traditional "cut and sew" approach. METHODS This study involves patients undergoing surgical atrial fibrillation ablation (SAFA) at a single institution from 1999 to 2005. Type of concomitant procedures, preoperative clinical characteristics, and chronicity of AF were evaluated in overall patient population. Parameters including surgical approach, lesion pattern, and energy source used were collected intraoperatively. Clinical outcomes examined were postoperative rhythm success, stroke, early mortality, and long-term survival. RESULTS Three hundred thirty-nine patients were identified. Three hundred twenty-eight (96.8%) patients had associated cardiac disease and underwent concomitant procedures; 75.8% of patients had persistent AF. Energy sources used were microwave (49.8%), radiofrequency (42.2%), and laser (8.0%). In 41.9% of cases a pulmonary vein encircling lesion was the only lesion created. Combination lesion sets were performed in the remaining cases. Rhythm success rates at 3, 6, 12, and 24 months were 74.1%, 68.2%, 74.5%, and 71.1%, respectively. Patients who underwent surgical removal of left atrial appendage by means of stapling or simple excision had no early postoperative stroke. Early mortality was 4.9%. Postoperative survival rates at 1, 3, and 5 years were 89.6%, 83.1%, and 78.0%. CONCLUSIONS Surgical ablation of atrial fibrillation is a safe and effective procedure in restoring sinus rhythm with excellent postoperative survival rates. Further advancements in the field will eventually result in minimally invasive procedures with higher success rates.
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Barili F, Polvani G, Topkara VK, Dainese L, Cheema FH, Roberto M, Naliato M, Parolari A, Alamanni F, Biglioli P. Role of Hyperbaric Oxygen Therapy in the Treatment of Postoperative Organ/Space Sternal Surgical Site Infections. World J Surg 2007; 31:1702-6. [PMID: 17551783 DOI: 10.1007/s00268-007-9109-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A prospective trial was designed to evaluate the effect of hyperbaric oxygen (HBO) therapy on organ/space sternal surgical site infections (SSIs) following cardiac surgery that requires sternotomy. METHODS A total of 32 patients who developed postoperative organ/space sternal SSI were enrolled in this study from 1999 through 2005. All patients were offered HBO therapy. Group 1 included the patients who accepted and were able to undergo HBO therapy (n = 14); group 2 included patients who refused HBO therapy or had contraindications to it (n = 18). RESULTS The two groups were well matched at baseline with comparable preoperative clinical characteristics and operative factors. Staphylococcus was the most common pathogen for both groups. The duration of infection was similar in groups 1 and 2 (31.8 7.6 vs. 29.3 5.7 days, respectively, p = 0.357). The infection relapse rate was significantly lower in group 1 (0% vs. 33.3%, p = 0.024). Moreover, the duration of intravenous antibiotic use (47.8 +/- 7.4 vs. 67.6 +/- 25.1 days, p = 0.036) and total hospital stay (52.6 +/- 9.1 vs. 73.6 +/- 24.5 days, p = 0.026) were both significantly shorter in group 1. CONCLUSION Hyperbaric oxygen is a valuable addition to the armamentarium available to physicians for treating postoperative organ/space sternal SSI.
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97
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Barili F, Dainese L, Cheema FH, Dell'Antonio G, Topkara VK, Rossoni G, Guarino A, Micheli B, Doglioni C, Biglioli P, Polvani G. Rates of cycling cells in cryopreserved valvular homograft: a preliminary study. Artif Organs 2007; 31:152-4. [PMID: 17298405 DOI: 10.1111/j.1525-1594.2007.00355.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Some investigators claim that the viability of cryopreserved human valvular homograft is necessary for the duration of implanted homograft. In this preliminary study, the percentage of cycling cells in cryopreserved valvular homografts was evaluated with the use of monoclonal Ki-67 antibody. Three human aortic valves were harvested from multiorgan donors and cryopreserved. Sections of 5 microm in thickness were stained with monoclonal Ki-67 antibody. The proportion of endothelial cells with Ki-67 positive nuclei was 1.80 +/- 0.20%. No differences in distribution were observed from basal to marginal sites. Few fibroblasts showed Ki-67-immunopositivity (0.10 +/- 0.06%) while the Ki-67 immunostaining was 0.80 +/- 0.20% in myocytes. Our preliminary study shows that cryopreserved valvular homograft cells are not only viable but they also have the potential to replicate. These data can lead to the hypothesis that valvular cells could actively replicate even after implantation, permitting cellular renewal and regeneration of extracellular matrix's components.
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Schulman AR, Martens TP, Christos PJ, Russo MJ, Comas GM, Cheema FH, Naseem TM, Wang R, Idrissi KA, Bailey SH, Naka Y. Comparisons of infection complications between continuous flow and pulsatile flow left ventricular assist devices. J Thorac Cardiovasc Surg 2007; 133:841-2. [PMID: 17320612 DOI: 10.1016/j.jtcvs.2006.09.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 09/28/2006] [Indexed: 11/25/2022]
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99
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Bardakci H, Cheema FH, Topkara VK, Dang NC, Martens TP, Mercando ML, Forster CS, Benson AA, George I, Russo MJ, Oz MC, Esrig BC. Discharge to Home Rates Are Significantly Lower for Octogenarians Undergoing Coronary Artery Bypass Graft Surgery. Ann Thorac Surg 2007; 83:483-9. [PMID: 17257973 DOI: 10.1016/j.athoracsur.2006.09.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 09/12/2006] [Accepted: 09/14/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of coronary artery bypass graft surgery (CABG) performed in elderly patients has been increasing over recent years. We sought to evaluate clinical outcomes of octogenarians undergoing CABG using an audited state-wide mandatory database. METHODS New York State Department of Health's Cardiac Reporting System was analyzed from 1998 to 2002. In all, 88,154 patients undergoing isolated CABG were identified. Patients were divided into four age groups: less than 50 years (group 1, n = 6,527), 50 to 64 years (group 2, n = 30,088), 65 to 79 years (group 3, n = 43,369), and 80 years and above (group 4, n = 8,170). RESULTS Of all patients, 9.3% were octogenarians. In addition to marginally worse coronary artery disease, octogenarians generally manifested a higher incidence of preoperative risk factors such as cerebrovascular disease, peripheral vascular disease, and congestive heart failure compared with younger patients at baseline. Both length of hospital stay and in-hospital mortality rate were significantly higher among octogenarians. The incidence of postoperative complications was higher among octogenarians. Multivariate analysis demonstrated renal failure requiring dialysis (odds ratio [OR] = 4.4), myocardial infarction within 6 hours before surgery (OR = 3.6), chronic obstructive pulmonary disease (OR = 1.7), congestive heart failure at admission (OR = 1.7), emergent operation (OR = 1.6), Canadian Cardiovascular Society functional class IV (OR = 1.5), hypertension (OR = 1.4), and low ejection fraction (OR = 0.98) to be significant independent predictors of in-hospital mortality of octogenarians. Discharge to home rates were significantly lower for octogenarians. CONCLUSIONS Although early outcomes in octogenarians are acceptable, these factors alone are not sufficient to reflect overall success of CABG in these patients, given the strikingly lower discharge to home rates. Attention to full functional recovery in octogenarians is essential.
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100
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Russo MJ, Chen JM, Sorabella RA, Martens TP, Garrido M, Davies RR, George I, Cheema FH, Mosca RS, Mital S, Ascheim DD, Argenziano M, Stewart AS, Oz MC, Naka Y. The effect of ischemic time on survival after heart transplantation varies by donor age: An analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 2007; 133:554-9. [PMID: 17258599 DOI: 10.1016/j.jtcvs.2006.09.019] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 07/03/2006] [Accepted: 09/07/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES (1) To examine the interaction of donor age with ischemic time and their effect on survival and (2) to define ranges of ischemic time associated with differences in survival. METHODS The United Network for Organ Sharing provided de-identified patient-level data. The study population included 33,640 recipients undergoing heart transplantation between October 1, 1987, and December 31, 2004. Recipients were divided by donor age into terciles: 0 to 19 years (n = 10,814; 32.1%), 20 to 33 years (11,410, 33.9%), and 34 years or more (11,416, 33.9%). Kaplan-Meier survival functions and Cox regression were used for time-to-event analysis. Receiver operating characteristic curves and stratum-specific likelihood ratios were generated to compare 5-year survival at various thresholds for ischemic time. RESULTS In univariate Cox proportional hazards regression, the effect of ischemic time on survival varied by donor age tercile: 0 to 19 years (P = .141), 20 to 33 years (P < .001), and 34 years or more (P < .001). These relationships persisted in multivariable regression. Threshold analysis generated a single stratum (0.37-12.00 hours) in the 0- to 19-year-old group with a median survival of 11.4 years. However, in the 20- to 33-year-old-group, 3 strata were generated: 0.00 to 3.49 hours (limited), 3.50 to 6.24 hours (prolonged), and 6.25 hours or more (extended), with median survivals of 10.6, 9.9, and 7.3 years, respectively. Likewise, 3 strata were generated in the group aged 34 years or more: 0.00 to 3.49 (limited), 3.50 to 5.49 (prolonged), and 5.50 or more (extended), with median survivals of 9.1, 8.5, and 6.3 years, respectively. CONCLUSIONS The effect of ischemic time on survival after heart transplantation is dependent on donor age, with greater tolerance for prolonged ischemic times among grafts from younger donors. Both donor age and anticipated ischemic time must be considered when assessing a potential donor.
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