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Chandra R, Heid CA. The Conduit Conundrum: A Commentary on "Outcomes of Radial Artery Versus Saphenous Vein as a Second Conduit After Coronary Artery Bypass Grafting". Am J Cardiol 2024; 217:158-160. [PMID: 38417649 DOI: 10.1016/j.amjcard.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Chandra R, Meier J, Marshall N, Chuckaree I, Harirah O, Khoury MK, Ring WS, Peltz M, Wait MA, Jessen ME, Hackmann AE, Heid CA. Safety-Net Hospital Status Is Associated With Coronary Artery Bypass Grafting Outcomes at an Urban Academic Medical Center. J Surg Res 2024; 294:112-121. [PMID: 37866066 DOI: 10.1016/j.jss.2023.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/25/2023] [Accepted: 08/27/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Socioeconomic disparities impact outcomes after cardiac surgery. At our institution, cardiac surgery cases from the safety-net, county funded hospital (CH), which primarily provides care for underserved patients, are performed at the affiliated university hospital. We aimed to investigate the association of socioeconomic factors and CH referral status with outcomes after coronary artery bypass grafting (CABG). METHODS The institutional Adult Cardiac Surgery database was queried for perioperative and demographic data from patients who underwent isolated CABG between January 2014 and June 2020. The primary outcome was major adverse cardiovascular event (MACE), a composite of postoperative myocardial infarction, stroke, or death. Secondary outcomes included individual complications. Chi-square, Wilcoxon rank-sum, and logistic regression analyses were used to compare differences between CH and non-CH cohorts. RESULTS We included 836 patients with 472 (56.5%) from CH. Compared to the non-CH cohort, CH patients were younger, more likely to be Hispanic, non-English speaking, and be completely uninsured or require state-specific financial assistance. CH patients were more likely to have a history of tobacco and drug use, liver disease, diabetes, prior myocardial infarction, and greater degrees of left main coronary and left anterior descending artery stenosis. CH cases were less likely to be elective. The incidence of MACE was significantly higher in the CH cohort (16.3% versus 8.2%, P = 0.001). There were no significant differences in 30-d mortality, home discharge, prolonged mechanical ventilation, bleeding, sepsis, pneumonia, new dialysis requirement, cardiac arrest, or multiorgan system failure between cohorts. CH patients were more likely to develop renal failure and less likely to develop atrial fibrillation. On multivariable analysis, CH status (odds ratio 2.39, 95% confidence interval 1.25-4.55, P = 0.008) was independently associated with MACE. CONCLUSIONS CH patients undergoing CABG presented with greater comorbidity burden, more frequently required nonelective surgery, and are at significantly higher risk of postoperative MACE.
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Affiliation(s)
- Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas
| | - Nicholas Marshall
- Parkland Memorial Hospital, Dallas, Texas; School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ishwar Chuckaree
- Parkland Memorial Hospital, Dallas, Texas; School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Omar Harirah
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Memorial Hospital, Dallas, Texas
| | - W Steves Ring
- Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthias Peltz
- Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A Wait
- Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael E Jessen
- Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy E Hackmann
- Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher A Heid
- Parkland Memorial Hospital, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Chandra R, Heid CA, Chuckaree I, Marshall N, Wait MA, Peltz M, Murala JS. How I Teach It: The Ross Procedure Using Explanted Hearts During Orthotopic Heart Transplantation. CJC Open 2023; 5:700-703. [PMID: 37744656 PMCID: PMC10516720 DOI: 10.1016/j.cjco.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher A. Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ishwar Chuckaree
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicholas Marshall
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael A. Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John S. Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Heid CA. Management of Left Ventricular Thrombus. Am J Cardiol 2023; 194:111-112. [PMID: 36925398 DOI: 10.1016/j.amjcard.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Jones BA, Thornton MA, Heid CA, Burke KL, Scrushy MG, Abdelfattah KR, Wolf SE, Khoury MK. Survival after multiple episodes of cardiac arrest. Heart Lung 2023; 58:98-103. [PMID: 36446264 DOI: 10.1016/j.hrtlng.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is widely used in response to cardiac arrest. However, little is known regarding outcomes for those who undergo multiple episodes of cardiac arrest while in the hospital. OBJECTIVES The purpose of this study was to evaluate the association of multiple cardiac events with in-hospital mortality for patients admitted to our tertiary care hospital who underwent multiple code events. METHODS We performed a retrospective cohort study on all patients who underwent cardiac arrest from 2012 to 2016. Primary outcome was survival to discharge. Secondary outcomes included post-cardiac-arrest neurologic events (PCANE), non-home discharge, and one-year mortality. RESULTS There were 622 patients with an overall mortality rate of 78.0%. Patients undergoing CPR for cardiac arrest once during their admission had lower in-hospital mortality rates compared to those that had multiple (68.9% versus 91.3%, p<.01). Subset analysis of those who had multiple episodes of CPR revealed that more than one event within a 24-hour period led to significantly higher in-hospital mortality rates (94.7% versus 74.4%, p<.01). Other variables associated with in-hospital mortality included body mass index, female sex, malignancy, and increased down time per code. Patients that had a non-home discharge were more likely to have sustained a PCANE than those that were discharged home (31.4% versus 3.9%, p<.01). A non-home discharge was associated with higher one-year mortality rates compared to a home discharge (78.4% versus 54.3%, p=.01). CONCLUSION Multiple codes within a 24-hour period and the average time per code were associated with in-hospital mortality in cardiac arrest patients.
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Affiliation(s)
- Bayley A Jones
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Micah A Thornton
- Southern Methodist University, Department of Statistical Science; Dallas, TX
| | - Christopher A Heid
- University of Texas, Southwestern; Department of Cardiothoracic Surgery; Division of Cardiac Surgery; Dallas, TX
| | - Kristen L Burke
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Marinda G Scrushy
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Kareem R Abdelfattah
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX
| | - Steven E Wolf
- University of Texas Medical Branch, Galveston; Department of Surgery; Division of Trauma and Acute Care Surgery; Galveston, TX
| | - Mitri K Khoury
- University of Texas, Southwestern Medical Center; Department of Surgery; Division of Trauma and Acute Care Surgery; Dallas, TX; Massachusetts General Hospital; Department of Surgery; Division of Vascular and Endovascular Surgery; Boston, MA.
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Kalsbeek A, Chuckaree I, Khoury MK, Leonard G, Maaraoui K, Liu C, Hackmann A, Huffman LC, Peltz M, Ring WS, Wait MA, Heid CA. Impact of cerebrovascular accidents on lung transplant survival. J Card Surg 2022; 37:4719-4725. [PMID: 36345686 DOI: 10.1111/jocs.17086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/27/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cerebrovascular accidents (CVA) are a source of postoperative morbidity. Existing data on CVA after lung transplantation (LT) are limited. We aimed to evaluate the impact of CVA on LT survival. METHODS A retrospective analysis of LT recipients at the University of Texas Southwestern Medical Center was performed. Data was obtained from the institutional thoracic transplant database between January 2012 and December 2018, which consisted of 476 patients. Patients were stratified by the presence of a postoperative CVA. Univariate comparisons of baseline characteristics, operative variables, and postoperative outcomes between the cohorts were performed. Survival was analyzed by Kaplan-Meier method. Aalen's additive regression model was utilized to assess mortality hazard over time. RESULTS The incidence of CVA was 4.2% (20/476). Lung allocation score was higher in the CVA cohort (46.2 [41.7, 57.3] vs. 41.5 [35.8, 52.2], p = 0.04). There were no significant differences in operative variables. CVA patients had longer initial intensive care unit (ICU) stays (316 h [251, 557] vs. 124 [85, 218], p < 0.001) and longer length of stay (22 days [17, 53] vs. 15 [11, 26], p = 0.007). CVA patients required more ICU readmissions (35% vs. 15%, p = 0.02) and had a lower rates of home discharge (35% vs. 71%, p < 0.001). Thirty-day mortality was higher in the CVA cohort (20% vs. 1.3%, p < 0.001). Overall survival was lower in the CVA cohort (log rank p = 0.044). CONCLUSIONS Postoperative CVA following LT was associated with longer ICU stays, more ICU readmissions, longer length of stay, and fewer home discharges. Thirty day and long-term mortality were significantly higher in the CVA group.
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Affiliation(s)
- Anya Kalsbeek
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Ishwar Chuckaree
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Grey Leonard
- Department of Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Kayla Maaraoui
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA
| | - Charles Liu
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA
| | - Amy Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Lynn C Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - W Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
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Liu CR, Heid CA, Hauptmann E, Ali M, Pruszynski J, Pillai A, Banga A, Wait MA, Huffman LC, Peltz M, Hackmann AE, Jessen ME, Ring WS, Murala JS. Donor substance use and lung transplantation: A single center experience. Transplantation Reports 2022. [DOI: 10.1016/j.tpr.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chandra R, Meier J, Khoury MK, Weisberg A, Nguyen YT, Peltz M, Jessen ME, Heid CA. Homelessness and Race are Mortality Predictors in US Veterans Undergoing CABG. Semin Thorac Cardiovasc Surg 2022:S1043-0679(22)00230-1. [PMID: 36223817 DOI: 10.1053/j.semtcvs.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Coronary artery disease requiring surgical revascularization is prevalent in United States Veterans. We aimed to investigate preoperative predictors of 30-day mortality following coronary artery bypass grafting (CABG) in the Veteran population. The Veterans Affairs Surgical Quality Improvement (VASQIP) national database was queried for isolated CABG cases between 2008 and 2018. The primary outcome was 30-day mortality. A multivariable logistic regression was performed to assess for independent predictors of the primary outcome. A P-value of <0.05 was considered statistically significant. A total of 32,711 patients were included. The 30-day mortality rate was 1.37%. Multivariable analysis identified the following predictors of 30-day mortality: African-American race (OR 1.46, 95% CI 1.09-1.96); homelessness (OR 6.49, 95% CI 3.39-12.45); female sex (OR 2.15, 95% CI 1.08-4.30); preoperative myocardial infarction within 7 days (OR 1.49, 95% CI 1.06-2.10) or more than 7 days before CABG (OR 1.34, 95% CI 1.04-1.72); partially/fully dependent functional status (OR 1.44, 95% CI 1.07-1.93); chronic obstructive pulmonary disease (OR 1.54, 95% CI 1.24-1.92); mild (OR 1.48, 95% CI 1.04-2.11) and severe aortic stenosis (OR 2.06, 95% CI 1.37-3.09); moderate (OR 1.88, 95% CI 1.31-2.72), or severe (OR 2.99, 95% CI 1.71-5.22) mitral regurgitation; cardiomegaly (OR 1.73, 95% CI 1.35-2.22); NYHA Class III/IV heart failure (OR 2.05, 95% CI 1.10-3.83); and urgent/emergent operation (OR 1.42, 95% CI 1.08-1.87). The 30-day mortality rate in US Veterans undergoing isolated CABG between 2008 and 2018 was 1.37%. In addition to established clinical factors, African-American race and homelessness were independent demographic predictors of 30-day mortality.
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Affiliation(s)
- Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, North Texas Veterans Affairs Health Care System, Dallas, Texas.
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Asher Weisberg
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Yen T Nguyen
- Department of Surgery, North Texas Veterans Affairs Health Care System, Dallas, Texas; Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Liu CR, Heid CA, Chandra R, Hauptmann E, Brickner ME, Hwang M, Wait MA. Gemella morbillorum mitral valve endocarditis in a patient with a history of mitral valve annuloplasty. BMJ Case Rep 2022; 15:e247033. [PMID: 35487637 PMCID: PMC9058679 DOI: 10.1136/bcr-2021-247033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/03/2022] Open
Abstract
A woman with a history of congenital heart disease status post multiple valve operations including mitral valve repair presented with 2 months of low back pain and general malaise. Blood cultures returned positive for Gram-positive cocci. While transthoracic echocardiography did not identify vegetations, transoesophageal echocardiography visualised vegetations on the patient's mitral valve, which had previously undergone repair with annuloplasty. The patient was found to have infectious endocarditis (IE), caused by Gemella morbillorum The patient was treated with over 6 weeks of intravenous antibiotics. Cases of Gemella-associated IE are rare and largely relegated to case reports. This report aims to contribute to the literature regarding this subject, and to further characterise the presentation and treatment of Gemella-associated IE. Additionally, this report emphasises the importance of maintaining a high suspicion of IE in a patient with non-specific malaise in the setting of prior cardiac valve operation.
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Affiliation(s)
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern, Dallas, Texas, USA
| | - Raghav Chandra
- Department of Surgery, UT Southwestern, Dallas, Texas, USA
| | | | | | - Michael Hwang
- School of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern, Dallas, Texas, USA
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Khoury MK, Heid CA, Rectenwald JE, Acher CW, Tsai S, Ramanan B, Timaran CH, Modrall JG. Understanding who Benefits from Endovascular Aortic Repair in those Deemed Unfit for Open Repair. J Vasc Surg 2022; 76:419-427.e3. [DOI: 10.1016/j.jvs.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/05/2022] [Indexed: 11/16/2022]
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Khoury MK, Thornton MA, Heid CA, Babb J, Ramanan B, Tsai S, Kirkwood ML, Timaran CH, Modrall JG. Endovascular Aortic Repair in Patients of Advanced Age. J Endovasc Ther 2021; 29:381-388. [PMID: 34622707 DOI: 10.1177/15266028211049342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Treatment decisions for the elderly with abdominal aortic aneurysms (AAAs) are challenging. With advancing age, the risk of endovascular aneurysm repair (EVAR) increases while life expectancy decreases, which may nullify the benefit of EVAR. The purpose of this study was to quantify the impact of EVAR on 1-year mortality in patients of advanced age. MATERIALS AND METHODS The 2003-2020 Vascular Quality Initiative Database was utilized to identify patients who underwent EVAR for AAAs. Patients were included if they were 80 years of age or older. Exclusions included non-elective surgery or missing aortic diameter data. Predicted 1-year mortality of untreated AAAs was calculated based on a validated comorbidity score that predicts 1-year mortality (Gagne Index, excluding the component associated with AAAs) plus the 1-year aneurysm-related mortality without repair. The primary outcome for the study was 1-year mortality. RESULTS A total of 11 829 patients met study criteria. The median age was 84 years [81, 86] with 9014 (76.2%) being male. Maximal AAA diameters were apportioned as follows: 39.6% were <5.5 cm, 28.6% were 5.5-5.9 cm, 21.3% were 6.0-6.9 cm, and 10.6% were ≥7.0 cm. The predicted 1-year mortality rate without EVAR was 11.9%, which was significantly higher than the actual 1-year mortality rate with EVAR (8.2%; p<0.001). The overall rate of perioperative MACE was 4.4% (n = 516). Patients with an aneurysm diameter <5.5cm had worse actual 1-year mortality rates with EVAR compared to predicted 1-year mortality rates without EVAR. In contrast, those with larger aneurysms (≥5.5cm) had better actual 1-year mortality rates with EVAR. The benefit from EVAR for those with Gagne Indices 2-5 was largely restricted to those with AAAs ≥ 7.0cm; whereas those with Gagne Indices 0-1 experience a survival benefit for AAAs larger than 5.5 cm. CONCLUSION The current data suggest that EVAR decreases 1-year mortality rates for patients of advanced age compared to non-operative management in the elderly. However, the survival benefit is largely limited to those with Gagne Indices 0-1 with AAAs ≥ 5.5 cm and Gagne Indices 2-5 with AAAs ≥ 7.0 cm. Those of advanced age may benefit from EVAR, but realizing this benefit requires careful patient selection.
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Affiliation(s)
- Mitri K Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Micah A Thornton
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Babb
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bala Ramanan
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Surgical Services, Dallas VA Medical Center, Dallas, TX, USA
| | - Shirling Tsai
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Surgical Services, Dallas VA Medical Center, Dallas, TX, USA
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Gregory Modrall
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Surgical Services, Dallas VA Medical Center, Dallas, TX, USA
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Khoury MK, Heid CA, Thornton M, Kirkwood ML, Rectenwald JE, Acher C, Ramanan B, Tsai S, Timaran CH, Modrall G. Endovascular Aortic Repair in Those Unfit for Open Repair. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heid CA, Chandra R, Liu C, Pruszynski J, Khoury MK, Vela R, Zeng X, Maaraoui K, Kalsbeek A, Ring WS, Amin A, Murala J, Peltz M. Cardiac transplantation in adults with congenital heart disease: A single center case series. Clin Transplant 2021; 35:e14430. [PMID: 34288107 DOI: 10.1111/ctr.14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adult congenital heart disease (CHD) transplant recipients historically experienced worse survival early after transplantation. We aim to review updated trends in adult CHD transplantation. METHODS We performed a single center case series of adult cardiac transplants from January 2013 through July 2020. Outcomes of patients with CHD were compared to non-CHD. The primary outcome was overall survival. Secondary outcomes included a variety of post-operative complications. RESULTS 18/262 (7%) transplants were CHD recipients. CHD patients were younger with median age 41 (32-47) versus 58 (48-65) (P < .001). Fontan circulation for single ventricle physiology was present in 4/18 (22%) of CHD recipients, while 16/18 (89%) had systemic right ventricles. CHD recipients had higher rates of previous cardiovascular operations (94% vs. 51%, P < .001). 9/18 (50%) of CHD patients required reconstructive procedures at the time of transplant. Operative and cardiopulmonary bypass times were longer for the CHD cohort (7.5 h [6.6-8.5] vs. 5.6 h [4.6-7] P < .001) and (197 min [158-240] vs. 130 [105-167] P < .001), respectively. There were no differences in operative complications or survival between CHD and non-CHD recipients. CONCLUSIONS These data highlight the added technical challenges of performing adult CHD transplants. However, similar outcomes can be achieved as for non-CHD recipients. SUMMARY Modern advances in palliation of congenital heart defects (CHD) has led to increased survival into adulthood. Many of these patients require heart transplantation as adults. There are limited data on adult CHD transplantation. Historically, these patients have had worse perioperative outcomes with improved long-term survival. We retrospectively analyzed 262 heart transplants at a single center, 18 of which were for adult CHD. Here, we report our series of 18 CHD recipients. We detail the palliative history of all CHD patients and highlight the added technical challenges for each of the 18 patients at transplant. In our analysis, CHD patients had more prior cardiovascular surgeries as well as longer transplant operative and bypass times. Despite this, there were no differences in perioperative and long-term outcomes. We have added patient and institution specific data for transplanting patients with adult CHD. We hope that our experience will add to the growing body of literature on adult CHD transplantation.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Charles Liu
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Pruszynski
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan Vela
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xue Zeng
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kayla Maaraoui
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anya Kalsbeek
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - W Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alpesh Amin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Khoury MK, Heid CA, Babb J, Ramanan B, Tsai S, Kirkwood ML, Timaran CH, Modrall JG. Endovascular Aortic Repair Improves 1-Year Survival in Octogenarians. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Heid CA, Lopez V, Kernstine K. How I do it: robotic-assisted Ivor Lewis esophagectomy. Dis Esophagus 2020; 33:6006404. [PMID: 33241303 DOI: 10.1093/dote/doaa070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/01/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
Advances in minimally invasive techniques, including robotic surgical technology, have led to improved outcomes in esophagectomy. In this article, we detail our approach to the robotic Ivor Lewis esophagectomy.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Victor Lopez
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kemp Kernstine
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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Heid CA, Khoury MK, Thornton MA, Geoffrion TR, De Hoyos AL. Risk Factors for Nonhome Discharge After Esophagectomy for Neoplastic Disease. Ann Thorac Surg 2020; 111:1118-1124. [PMID: 32866477 DOI: 10.1016/j.athoracsur.2020.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Esophagectomies are known to be technically challenging operations that create significant physiologic changes. These patients often require assisted care postoperatively that necessitates a nonhome discharge. The purpose of this study was to assess factors associated with nonhome discharge after esophagectomy for neoplastic disease. METHODS The 2016 to 2017 American College of Surgeons National Surgical Quality Improvement Program Esophagectomy database was queried to identify patients who underwent esophagectomy for a neoplasm. Patients were excluded if they died within 30 days of their operation, the index operation was considered emergent, or had missing data for the variables of interest. Multivariable analysis was performed to identify which factors were predictive of nonhome discharge. RESULTS One thousand seven patients were included. Of those, 121 (12.0%) had a nonhome discharge. Multivariable analysis showed that the following factors were associated with nonhome discharge: Modified Charlson comorbidity index (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.49-2.86), partially dependent preoperative functional status (aOR, 13.18; 95% CI, 1.07-315.67), urinary tract infection (aOR, 5.25; 95% CI, 1.32-20.41), and length of stay (aOR, 1.12; 95% CI, 1.08-1.16). CONCLUSIONS We identified various factors associated with nonhome discharge. Early identification of patients who are at risk for nonhome discharge is important for early discharge planning, which may decrease nonmedical delays and healthcare costs.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Wisconsin, Madison, Wisconsin
| | - Micah A Thornton
- Department of Statistical Science, Southern Methodist University, Dallas, Texas
| | - Tracy R Geoffrion
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alberto L De Hoyos
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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17
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Khoury MK, Heid CA, Cripps MW, Pickett ML, Nagaraj MB, Johns M, Lee F, Hennessy SA. Antifungal Therapy in Fungal Necrotizing Soft Tissue Infections. J Surg Res 2020; 256:187-192. [PMID: 32711174 DOI: 10.1016/j.jss.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies associated with high morbidity and mortality. Fungal NSTIs are considered rare and have been largely understudied. The purpose of this study was to study the impact of fungal NSTIs and antifungal therapy on mortality after NSTIs. METHODS A retrospective chart review was performed on patients with NSTIs from 2012 to 2018. Patient baseline characteristics, microbiologic data, antimicrobial therapy, and clinical outcomes were collected. Patients were excluded if they had comfort care before excision. The primary outcome measured was in-hospital mortality. RESULTS A total of 215 patients met study criteria with a fungal species identified in 29 patients (13.5%). The most prevalent fungal organism was Candida tropicalis (n = 11). Fungal NSTIs were more prevalent in patients taking immunosuppressive medications (17.2% versus 3.2%, P = 0.01). A fungal NSTI was significantly associated with in-hospital mortality (odds ratio, 3.13; 95% confidence interval, 1.16-8.40; P = 0.02). Furthermore, fungal NSTI patients had longer lengths of stay (32 d [interquartile range, 16-53] versus 19 d [interquartile range, 11-31], P < 0.01), more likely to require initiation of renal replacement therapy (24.1% versus 8.6%, P = 0.02), and more likely to require mechanical ventilation (64.5% versus 42.0%, P = 0.02). Initiation of antifungals was associated with a significantly lower rate of in-hospital mortality (6.7% versus 57.1%, P = 0.01). CONCLUSIONS Fungal NSTIs are more common in patients taking immunosuppressive medications and are significantly associated with in-hospital mortality. Antifungal therapy is associated with decreased in-hospital mortality in those with fungal NSTIs. Consideration should be given to adding antifungals in empiric treatment regimens, especially in those taking immunosuppressive medications.
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Affiliation(s)
- Mitri K Khoury
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas; Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Christopher A Heid
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael W Cripps
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Maryanne L Pickett
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Madhuri B Nagaraj
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Meagan Johns
- Division of Pharmacologic Sciences, Department of Biomedical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Francesca Lee
- Department of Internal Medicine and Pathology, UT Southwestern Medical Center, Dallas, Texas
| | - Sara A Hennessy
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
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18
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Heid CA, Khoury MK, Maaraoui K, Liu C, Peltz M, Wait MA, Ring WS, Huffman LC. Acute Kidney Injury in Patients Undergoing Cardiopulmonary Bypass for Lung Transplantation. J Surg Res 2020; 255:332-338. [PMID: 32599452 DOI: 10.1016/j.jss.2020.05.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) is often used to support patients undergoing lung transplantation who are intolerant of anatomic manipulation or single lung ventilation during the procedure. However, CPB may be associated with adverse outcomes. We evaluated the hypothesis that CPB is associated with increased acute kidney injury (AKI) and postoperative mortality after lung transplantation. MATERIALS AND METHODS This was a retrospective review of our institutional lung transplant database at the University of Texas Southwestern Medical Center from 2012 to 2018. Patients were grouped based on their need for CPB. The primary outcome was AKI within 48 h of transplantation, which was defined as Kidney Disease Improving Global Outcomes stage 1 or greater. Secondary outcomes included all-cause mortality. RESULTS A total of 426 patients underwent lung transplantation with 39.0% (n = 166) requiring CPB. There were no differences in demographics and comorbidities, including baseline renal function, between CPB and no CPB. CPB use was higher in recipients with interstitial lung diseases and primary pulmonary hypertension. Median lung allocation score was higher in those needing CPB (47 [interquartile range, 40-59] versus 39 [interquartile range, 35-47]). Patients requiring CPB were significantly more likely to experience AKI (61.44% versus 36.5.3%, P < 0.01) and postoperative hemodialysis (6.6% versus 0.4%, P < 0.01). On multivariable analysis, CPB was significantly associated with postoperative AKI (odds ratio, 1.66; 95% CI, 1.01-2.75; P = 0.04). Thirty-day mortality was higher in patients undergoing CPB (4.2% versus 0.8%, P = 0.03). CONCLUSIONS CPB for lung transplantation is associated with a higher incidence of AKI, renal failure requiring hemodialysis, and 30-d mortality. CPB should be used selectively for lung transplantation.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kayla Maaraoui
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Charles Liu
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - W Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lynn C Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Khoury MK, Heid CA, Pickett ML, Nagaraj MB, Hennessy SA. Fungal Necrotizing Soft Tissue Infections Are Associated with Significantly Increased Mortality. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Ketchel BP, Heid CA, Wood GL, Miller MJ, Mott AG, Anderson RJ, Salamo GJ. Three-dimensional color holographic display. Appl Opt 1999; 38:6159-6166. [PMID: 18324139 DOI: 10.1364/ao.38.006159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Three-dimensional (3D) color holograms are recorded in a cerium-doped, strontium barium niobate (SBN:60) photorefractive crystal. These holograms are shown to reconstruct true color reproductions of the original object with an observable field of view of 37 degrees. Angle multiplexing of two or more 3D color holograms is also demonstrated with angle tuning of the reference beam corresponding to a separation angle between stored images of 0.082 degrees. Each of these results is compared with corresponding theoretical predictions.
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Affiliation(s)
- B P Ketchel
- US Army Research Laboratory, 2800 Powder Mill Road, Adelphi, Maryland 20783-1197, USA
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Martin TG, Somberg KA, Meng YG, Cohen RL, Heid CA, de Sauvage FJ, Shuman MA. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation. Ann Intern Med 1997; 127:285-8. [PMID: 9265428 DOI: 10.7326/0003-4819-127-4-199708150-00005] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Thrombocytopenia is a common manifestation of cirrhosis. OBJECTIVES To determine plasma thrombopoietin levels in cirrhotic patients with thrombocytopenia, monitor those levels before and after orthotopic liver transplantation, and compare thrombopoietin messenger RNA (mRNA) levels in liver samples from cirrhotic patients and controls. DESIGN A cross-sectional study of patients with cirrhosis, including a small subset of patients who had orthotopic liver transplantation. SETTING University-affiliated hospital. PATIENTS 44 patients with cirrhosis, including 17 patients who had orthotopic liver transplantation. INTERVENTION Orthotopic liver transplantation. MEASUREMENTS Plasma thrombopoietin levels in all patients, platelet counts in all patients, and thrombopoietin mRNA levels in liver samples from nine patients with cirrhosis and eight controls. RESULTS Thrombopoietin levels were undetectable in 39 of 44 patients with cirrhosis. In 16 of 17 patients, the levels became detectable after liver transplantation. Thrombopoietin mRNA levels were decreased in liver samples from patients with cirrhosis compared with controls (P = 0.0103). CONCLUSIONS The low thrombopoietin levels in cirrhotic patients with thrombocytopenia and the increased levels after orthotopic liver transplantation suggest that impaired production of thrombopoietin may contribute to thrombocytopenia associated with cirrhosis.
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Affiliation(s)
- T G Martin
- University of California, San Francisco, USA
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Abstract
We have developed a novel "real time" quantitative PCR method. The method measures PCR product accumulation through a dual-labeled fluorogenic probe (i.e., TaqMan Probe). This method provides very accurate and reproducible quantitation of gene copies. Unlike other quantitative PCR methods, real-time PCR does not require post-PCR sample handling, preventing potential PCR product carry-over contamination and resulting in much faster and higher throughput assays. The real-time PCR method has a very large dynamic range of starting target molecule determination (at least five orders of magnitude). Real-time quantitative PCR is extremely accurate and less labor-intensive than current quantitative PCR methods.
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Affiliation(s)
- C A Heid
- BioAnalytical Technology Department, Genentech, Inc., South San Francisco, California 94080, USA
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23
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Abstract
We have developed a novel "real time" quantitative PCR method. The method measures PCR product accumulation through a dual-labeled fluorogenic probe (i.e., TaqMan Probe). This method provides very accurate and reproducible quantitation of gene copies. Unlike other quantitative PCR methods, real-time PCR does not require post-PCR sample handling, preventing potential PCR product carry-over contamination and resulting in much faster and higher throughput assays. The real-time PCR method has a very large dynamic range of starting target molecule determination (at least five orders of magnitude). Real-time quantitative PCR is extremely accurate and less labor-intensive than current quantitative PCR methods.
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Affiliation(s)
- C A Heid
- BioAnalytical Technology Department, Genentech, Inc., South San Francisco, California 94080, USA
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24
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Abstract
A novel approach to quantitative reverse transcriptase polymerase chain reaction (QC RT-PCR) using real time detection and the 5' nuclease assay has been developed. Cystic fibrosis transmembrane transductance regulator (CFTR) target mRNA is reverse transcribed, amplified, detected, and quantitated in real time. A fluorogenic probe was designed to detect the CFTR amplicon. Relative increase in 6-carboxy-fluorescein reporter fluorescent emission is monitored during PCR amplification using an analytical thermal cycler. An internal control template containing the same primer sequences as the CFTR amplicon, but a different internal sequence, has been designed as a control. An internal control probe with a reporter fluorescent dye tetrachloro-6-carboxy-fluorescein was designed to hybridize to the internal control amplicon. The internal control template is placed in each reaction tube and is used for quantitative analysis of the CFTR mRNA. This method provides a convenient and high-throughput format for QC RT-PCR.
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Affiliation(s)
- U E Gibson
- Genentech, Inc., South San Francisco, California 94080-4990, USA
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