1
|
Lee R, Lehr EJ. Reporting Conflicts of Interest in Robotic Cardiothoracic Surgical Research-It Is Still Partly Cloudy. Ann Thorac Surg 2024; 117:472-473. [PMID: 37393978 DOI: 10.1016/j.athoracsur.2023.06.008] [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: 05/28/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Richard Lee
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122
| | - Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
| |
Collapse
|
2
|
Bauer TM, Pienta M, Wu X, Lehr EJ, Whitman GJ, Kramer RS, Brevig J, Pagani FD, Likosky DS. Interhospital variability in failure to rescue rates following aortic valve surgery. JTCVS Open 2023; 16:123-138. [PMID: 38204724 PMCID: PMC10774948 DOI: 10.1016/j.xjon.2023.08.010] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 01/12/2024]
Abstract
Objective This study evaluated interhospital variability and determinants of failure-to-rescue for patients undergoing surgical aortic valve replacement. Methods An observational study was conducted among 28,842 patients undergoing aortic valve replacement with or without coronary artery bypass grafting between July 2011 and June 2017 across 90 hospitals participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Postoperative complications were defined as major (stroke, renal failure, reoperation, prolonged ventilation, sternal infection) and overall (major plus 14 other morbidities). Hospital terciles of observed to expected (O/E) mortality were compared on crude rates of major and overall complications, operative mortality, and failure to rescue (among major and overall complications). The correlation between hospital observed and expected failure-to-rescue rates was assessed. Results Median Society of Thoracic Surgeons Adult Cardiac Surgery Database predicted mortality risk was similar across hospital O:E mortality terciles (P = .10). As expected, mortality rates significantly increased across terciles (low O/E tercile: 1.6%, high O/E tercile: 4.7%; P < .001). Failure-to-rescue rates increased substantially across hospital mortality terciles among patients with major (low tercile, 8.8% and high tercile, 20.8%) and overall (low tercile, 3.0% and high tercile, 8.9%) complications. Hospital-level expected failure to rescue had a higher correlation with observed complications for overall complications (R2 = 0.71) compared with Society of Thoracic Surgeons major complications (R2 = 0.24). Conclusions Considerable interhospital variation exists in failure-to-rescue rates following aortic valve replacement. Hospitals in the low O/E mortality tercile experience failure to rescue nearly one-third less than those in the high O/E mortality tercile. Efforts to advance quality will benefit from identifying and disseminating optimal rescue strategies in this patient population.
Collapse
Affiliation(s)
- Tyler M. Bauer
- Department of Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Michael Pienta
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Eric J. Lehr
- Department of Cardiac Surgery, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, Wash
| | | | - Robert S. Kramer
- Division of Cardiothoracic Surgery, Maine Medical Center, Portland, Maine
| | - James Brevig
- Providence St Joseph Heart Institute, Renton, Wash
- Providence Regional Medical Center, Everett, Wash
| | | | | |
Collapse
|
3
|
Sebastian SA, Padda I, Lehr EJ, Johal G. Aficamten: A Breakthrough Therapy for Symptomatic Obstructive Hypertrophic Cardiomyopathy. Am J Cardiovasc Drugs 2023; 23:519-532. [PMID: 37526885 DOI: 10.1007/s40256-023-00599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
Aficamten is a novel cardiac myosin inhibitor that has demonstrated its ability to safely lower left ventricular outflow tract (LVOT) gradients and improve heart failure symptoms in patients with obstructive hypertrophic cardiomyopathy (HCM). Based on the REDWOOD-HCM open label extension (OLE) study, participants receiving aficamten had significantly reduced resting and Valsalva LVOT gradient within 2 weeks after initiating treatment, with ongoing improvements over 24 weeks, and recent evidence suggests effects can sustain up to 48 weeks. While beta-blockers, calcium channel blockers, and disopyramide have shown some benefits in managing HCM, they have limited direct impact on the underlying disease process in patients with obstructive HCM. Aficamten achieves its therapeutic effect by reducing hypercontractility and improving diastolic function in obstructive HCM. Mavacamten was the first cardiac myosin inhibitor approved for symptomatic obstructive HCM. However, aficamten has a shorter human half-life (t1/2) and fewer drug-drug interactions, making it a preferable treatment option. This review evaluates the long-term clinical value and safety of aficamten in patients with obstructive HCM based on available data from completed and ongoing clinical trials. Additionally, the molecular basis of sarcomere-targeted therapy in reducing LVOT gradients is explored, and its potential in managing obstructive HCM is discussed.
Collapse
Affiliation(s)
- Sneha Annie Sebastian
- Department of Internal Medicine, Azeezia Medical College, Kollam, Kerala, India.
- , Airdrie, Canada.
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, WA, USA
| |
Collapse
|
4
|
Chu MWA, Ruel M, Graeve A, Gerdisch MW, Damiano RJ, Smith RL, Keeling WB, Wait MA, Hagberg RC, Quinn RD, Sethi GK, Floridia R, Barreiro CJ, Pruitt AL, Accola KD, Dagenais F, Markowitz AH, Ye J, Sekela ME, Tsuda RY, Duncan DA, Swistel DG, Harville LE, DeRose JJ, Lehr EJ, Alexander JH, Puskas JD. Low-Dose vs Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Trial. Ann Thorac Surg 2023; 115:929-938. [PMID: 36610532 DOI: 10.1016/j.athoracsur.2022.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/04/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current guidelines recommend a target international normalized ratio (INR) range of 2.5 to 3.5 in patients with a mechanical mitral prosthesis. The Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) Mitral randomized controlled noninferiority trial assessed safety and efficacy of warfarin at doses lower than currently recommended in patients with an On-X (Artivion, Inc) mechanical mitral valve. METHODS After On-X mechanical mitral valve replacement, followed by at least 3 months of standard anticoagulation, 401 patients at 44 North American centers were randomized to low-dose warfarin (target INR, 2.0-2.5) or standard-dose warfarin (target INR, 2.5-3.5). All patients were prescribed aspirin, 81 mg daily, and encouraged to use home INR testing. The primary end point was the sum of the linearized rates of thromboembolism, valve thrombosis, and bleeding events. The design was based on an expected 7.3% event rate and 1.5% noninferiority margin. RESULTS Mean patient follow-up was 4.1 years. Mean INR was 2.47 and 2.92 (P <.001) in the low-dose and standard-dose warfarin groups, respectively. Primary end point rates were 11.9% per patient-year in the low-dose group and 12.0% per patient-year in the standard-dose group (difference, -0.07%; 95% CI, -3.40% to 3.26%). The CI >1.5%, thus noninferiority was not achieved. Rates (percentage per patient-year) of the individual components of the primary end point were 2.3% vs 2.5% for thromboembolism, 0.5% vs 0.5% for valve thrombosis, and 9.13% vs 9.04% for bleeding. CONCLUSIONS Compared with standard-dose warfarin, low-dose warfarin did not achieve noninferiority for the composite primary end point. (PROACT Clinicaltrials.gov number, NCT00291525).
Collapse
Affiliation(s)
- Michael W A Chu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | | | | | | | | | | | - Michael A Wait
- University of Texas Southwestern Medical Center (St. Paul's), Dallas, Texas
| | | | | | | | | | | | | | | | - Francois Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
| | | | - Jian Ye
- St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Ryan Y Tsuda
- Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona
| | - David A Duncan
- Novant Clinical Research Institute, Winston-Salem, North Carolina
| | | | - Lacy E Harville
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | | | | | | |
Collapse
|
5
|
Lehr EJ. Old Meets New - Cold ventricular fibrillatory arrest and robotic cardiac surgery. Ann Thorac Surg 2023; 115:1444-1445. [PMID: 36740006 DOI: 10.1016/j.athoracsur.2023.01.030] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Eric J Lehr
- Swedish Heart and Vascular Institute, Cardiac Surgery, Swedish Medical Center, 1600 East Jefferson, Seattle, WA 98122.
| |
Collapse
|
6
|
Likosky DS, Strobel RJ, Wu X, Kramer RS, Hamman BL, Brevig JK, Thompson MP, Ghaferi AA, Zhang M, Lehr EJ. Interhospital failure to rescue after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2023; 165:134-143.e3. [PMID: 33712236 PMCID: PMC8679510 DOI: 10.1016/j.jtcvs.2021.01.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We evaluated whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. METHODS An observational study was conducted among 83,747 patients undergoing isolated coronary artery bypass grafting between July 2011 and June 2017 across 90 hospitals. Failure to rescue was defined as operative mortality among patients developing complications. Complications included the Society of Thoracic Surgeons 5 major complications (stroke, surgical reexploration, deep sternal wound infection, renal failure, prolonged intubation) and a broader set of 19 overall complications. After creating terciles of hospital performance (based on observed:expected mortality), each tercile was compared on the basis of crude rates of (1) major and overall complications, (2) operative mortality, and (3) failure to rescue (among major and overall complications). The correlation between hospital observed and expected (to address confounding) failure to rescue rates was assessed. RESULTS Median Society of Thoracic Surgeons predicted mortality risk was similar across hospital observed:expected mortality terciles (P = .831). Mortality rates significantly increased across terciles (low tercile: 1.4%, high tercile: 2.8%). Although small in magnitude, rates of major (low tercile: 11.1%, high tercile: 12.2%) and overall (low tercile: 36.6%, high tercile: 35.3%) complications significantly differed across terciles. Nonetheless, failure to rescue rates increased substantially across terciles among patients with major (low tercile: 9.1%, high tercile: 14.3%) and overall (low tercile: 3.3%, high tercile: 6.8%) complications. Hospital observed and expected failure to rescue rates were positively correlated among patients with major (R2 = 0.14) and overall (R2 = 0.51) complications. CONCLUSIONS The reported interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals, including early recognition and management of complications.
Collapse
Affiliation(s)
- Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | | | - Xiaoting Wu
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Robert S Kramer
- Division of Cardiothoracic Surgery, Maine Medical Center, Portland, Me
| | - Baron L Hamman
- Cardiovascular & Thoracic Surgery, Texas Health Resources, Arlington, Tex
| | - James K Brevig
- Providence St Joseph Heart Institute, Renton, Wash; Providence Regional Medical Center, Everett, Wash
| | | | - Amir A Ghaferi
- Department of General Surgery, University of Michigan, Ann Arbor, Mich
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Eric J Lehr
- Department of Cardiac Surgery, Swedish Heart & Vascular Institute, Swedish Medical Center, Seattle, Wash
| |
Collapse
|
7
|
Chu MWA, Ruel M, Graeve A, Gerdisch MW, Damiano RJ, Smith RL, Keeling WB, Wait MA, Hagberg RC, Quinn RD, Sethi GK, Floridia R, Barreiro CJ, Pruitt AL, Accola KD, Dagenais F, Markowitz AH, Ye J, Sekela ME, Tsuda RY, Duncan DA, Swistel DG, Harville LE, DeRose JJ, Lehr EJ, Puskas JD. WITHDRAWN: Low-Dose Versus Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Controlled Trial. Ann Thorac Surg 2022:S0003-4975(22)00138-2. [PMID: 35101419 DOI: 10.1016/j.athoracsur.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Michael W A Chu
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francois Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Quebec City, QC, Canada
| | | | - Jian Ye
- St. Paul's and Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | | | - Lacy E Harville
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | | |
Collapse
|
8
|
Smith SP, Spear CR, Ryan PE, Stout DM, Youssef SJ, Hernandez RA, Barnhart GR, Lehr EJ. A Reproducible and Effective Technique for Coronary Sinus Injury Repair. Innovations (Phila) 2022; 17:37-41. [PMID: 35023798 DOI: 10.1177/15569845211060350] [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] [Indexed: 11/16/2022]
Abstract
Objective: Coronary sinus injury related to the use of a retrograde cardioplegia catheter is a rare but potentially life-threatening complication with mortality reported as high as 20%. We present a series of iatrogenic coronary sinus injuries as well as an effective method of repair without any ensuing mortality. Methods: There were 3,004 cases that utilized retrograde cardioplegia at our institution from 2007 to 2018. Of these, 15 patients suffered a coronary sinus injury, an incidence of 0.49%. A pericardial roof repair was performed in 14 cases in which autologous pericardium was sutured circumferentially to normal epicardium around the injury with purified bovine serum albumin and glutaraldehyde injected into the newly created space as a sealant. Incidence of perioperative morbidity and mortality, operative time, and length of stay were collected. Results: In our series, there were no intraoperative or perioperative mortalities. Procedure types included coronary artery bypass grafting (CABG), valve replacement and repair, or combined CABG and valve procedures. Median (interquartile range) cross-clamp time was 100 (88 to 131) minutes, cardiopulmonary bypass duration was 133 (114 to 176) minutes, and length of stay was 6 (4 to 8) days. None of the patients returned to the operating room for hemorrhage, and there were no complications associated with the repair of a coronary sinus injury when using the pericardial roof technique. Conclusions: Coronary sinus injuries can result in difficult to manage perioperative bleeding and potentially lethal consequences from cardiac manipulation. Our series supports the pericardial roof technique as an effective solution to a challenging intraoperative complication.
Collapse
Affiliation(s)
- Shane P Smith
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - Charlotte R Spear
- 12355West Virginia University School of Medicine, Morgantown, WV, USA
| | - Patrick E Ryan
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - David M Stout
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| | | | | | | | - Eric J Lehr
- 187868Swedish Heart and Vascular Institute, Seattle, WA, USA
| |
Collapse
|
9
|
Lehr EJ. Avoiding adverse outcomes while changing anastomotic technique in totally endoscopic robotic coronary artery bypass grafting. Ann Thorac Surg 2021; 114:482-483. [PMID: 34922912 DOI: 10.1016/j.athoracsur.2021.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
| |
Collapse
|
10
|
Brancato SC, Wang M, Spinelli KJ, Gandhavadi M, Worrall NK, Lehr EJ, DeBoard ZM, Fitton TP, Leiataua A, Piccini JP, Gluckman TJ. Temporal trends and predictors of surgical ablation for atrial fibrillation across a multistate healthcare system. Heart Rhythm O2 2021; 3:32-39. [PMID: 35243433 PMCID: PMC8859806 DOI: 10.1016/j.hroo.2021.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Multiple class I and class IIa recommendations exist related to surgical ablation (SA) of atrial fibrillation (AF) in patients undergoing cardiac surgery. Objective Examine temporal trends and predictors of SA for AF in a large US healthcare system. Methods We retrospectively analyzed data from the Society for Thoracic Surgery (STS) Adult Cardiac Surgery Database for 21 hospitals in the Providence St. Joseph Health system. All patients with preoperative AF who underwent isolated coronary artery bypass graft (CABG) surgery, isolated aortic valve replacement (AVR), AVR with CABG surgery (AVR+CABG), isolated mitral valve repair or replacement (MVRr), and MVRr with CABG surgery (MVRr+CABG) from July 1, 2014, to March 31, 2020 were included. Temporal trends in SA were evaluated using the Cochran-Armitage trends test. A multilevel logistic regression model was used to examine patient-, hospital-, and surgeon-level predictors of SA. Results Among 3124 patients with preoperative AF, 910 (29.1%) underwent SA. This was performed most often in those undergoing isolated MVRr (n = 324, 44.8%) or MVRr+CABG (n = 75, 35.2%). Rates of SA increased over time and were highly variable between hospitals. Years since graduation from medical school for the primary operator was one of the few predictors of SA: odds ratio (95% confidence interval) = 0.71 (0.56–0.90) for every 10-year increase. Annual surgical (both hospital and operator) and AF catheter ablation volumes were not predictive of SA. Conclusion Wide variability in rates of SA for AF exist, underscoring the need for greater preoperative collaboration between cardiologists, electrophysiologists, and cardiac surgeons.
Collapse
|
11
|
Smith SP, Van Essen CG, Zivin AH, Hayes PG, Ong ES, Lehr EJ. Inferior vena cava–right atrial junction stenosis requiring a multidisciplinary approach to resection and reconstruction. JTCVS Tech 2021; 11:31-33. [PMID: 35169728 PMCID: PMC8828792 DOI: 10.1016/j.xjtc.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
|
12
|
Hernandez R, Lehr EJ. Mortality following deep sternal wound infection-not just a short-term complication? Eur J Cardiothorac Surg 2021; 60:242-243. [PMID: 33842945 DOI: 10.1093/ejcts/ezab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roland Hernandez
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, WA, USA
| |
Collapse
|
13
|
Luc JGY, Ad N, Nguyen TC, Arora RC, Balkhy HH, Bender EM, Bethencourt DM, Bisleri G, Boyd D, Chu MWA, de la Cruz KI, DeAnda A, Engelman DT, Farkas EA, Fedoruk LM, Fiocco M, Forcillo J, Fradet G, Fremes SE, Gammie JS, Geirsson A, Gerdisch MW, Girard LN, Kaiser CA, Kaneko T, Kent WDT, Khabbaz KR, Khoynezhad A, Kiaii B, Lee R, Legare JF, Lehr EJ, MacArthur RGG, McCarthy PM, Mehall JR, Merrill WH, Moon MR, Ouzounian M, Peltz M, Perrault LP, Preventza O, Ramchandani M, Ramlawi B, Salenger R, Sekela ME, Sellke FW, Stulak JM, Sutter FP, Timek TA, Whitman G, Williams JB, Wong DR, Yanagawa B, Ye J, Zeigler SM. Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. J Card Surg 2021; 36:3040-3051. [PMID: 34118080 PMCID: PMC8447333 DOI: 10.1111/jocs.15681] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/31/2023]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID‐19 pandemic. Methods A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. Results Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID‐19, they were most worried with exposing their family to COVID‐19 (81%), followed by contracting COVID‐19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID‐19 burden, with higher COVID‐19 burden institutions more likely to resort to PPE conservation strategies. Conclusions The present study demonstrates the impact of COVID‐19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.
Collapse
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niv Ad
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Adventist White Oak Medical Center, Silver Spring, Maryland, USA
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas, USA
| | | | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Illinois, USA
| | - Edward M Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Daniel M Bethencourt
- Division of Cardiac Surgery, Orange Coast Memorial Medical Centers, Fountain Valley, California, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Douglas Boyd
- Division of Cardiothoracic Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Kim I de la Cruz
- Division of Cardiothoracic Surgery, Methodist Heart Hospital San Antonio, San Antonio, Texas, USA
| | - Abe DeAnda
- Division of Cardiovascular and Thoracic Surgery, UTMB-Galveston, Galveston, Texas, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, Springfield, Massachusetts, USA
| | - Emily A Farkas
- Division of Cardiac Surgery, ThedaCare Appleton Heart Institute, Appleton, Wisconsin, USA
| | - Lynn M Fedoruk
- Division of Cardiac Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, University of British Columbia, Victoria, British Columbia, Canada
| | - Michael Fiocco
- Division of Cardiac Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Jessica Forcillo
- Division of Cardiac Surgery, Université de Montréal, Department of Cardiac Surgery- Montréal University Hospital Centre (CHUM), Montreal, Quebec, Canada
| | - Guy Fradet
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Stephen E Fremes
- Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Gammie
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Arnar Geirsson
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc W Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Heart Center, Indianapolis, IN, USA
| | - Leonard N Girard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Clayton A Kaiser
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Khoynezhad
- Department of Cardiovascular Surgery, Memorial Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, California, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Richard Lee
- Division of Cardiothoracic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jean-Francois Legare
- Division of Cardiac Surgery, New Brunswick Heart Center, Dalhousie University, Saint John, New Brunswick, Canada
| | - Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, Washington, USA
| | - Roderick G G MacArthur
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - John R Mehall
- Division of Cardiac Surgery, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA
| | - Walter H Merrill
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Ourania Preventza
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mahesh Ramchandani
- Department of Cardiothoracic Surgery, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Valley Health System - Heart and Vascular Center, Winchester Medical Center, Winchester, VA, USA
| | - Rawn Salenger
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael E Sekela
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis P Sutter
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judson B Williams
- Department of Cardiovascular and Thoracic Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Daniel R Wong
- Division of Cardiac Surgery, Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jian Ye
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sanford M Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
14
|
Pulido J, Lehr EJ. Commentary: Exposing the Beast: The Importance of Provocative Maneuvers During Septal Myectomy. Semin Thorac Cardiovasc Surg 2021; 33:1043-1044. [PMID: 33609682 DOI: 10.1053/j.semtcvs.2021.01.038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Juan Pulido
- Critical Care Medicine and Cardiovascular Anesthesiology, Medical Director CVICU, Swedish Medical Center, US Anesthesia Partners, Cherry Hill Campus, Seattle, WA 98122.
| | - Eric J Lehr
- Department is Cardiac Surgery, Swedish Medical Center, Cherry Hill Campus, Seattle, WA 98122
| |
Collapse
|
15
|
Lehr EJ, Petrescu OM. Asymptomatic But Not Always Benign: New Insights Into Severe Mitral Regurgitation. Ann Thorac Surg 2020; 111:870-871. [PMID: 33058826 DOI: 10.1016/j.athoracsur.2020.07.062] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart & Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
| | - O Madalina Petrescu
- Division of Cardiology, Swedish Heart & Vascular Institute, Seattle, Washington
| |
Collapse
|
16
|
Lehr EJ, Zhang M. Effective Therapy or Double Trouble? Simultaneous ECMO and Thrombolysis of Acute Massive Pulmonary Embolism. Ann Thorac Surg 2020; 111:929-930. [PMID: 32987015 DOI: 10.1016/j.athoracsur.2020.06.145] [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: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart & Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
| | - Ming Zhang
- Division of Cardiology, Swedish Heart & Vascular Institute, Seattle, Washington
| |
Collapse
|
17
|
Hodson RW, Jin R, Ring ME, Gafoor S, Verburg S, Lehr EJ, Spinelli KJ. Intrathoracic complications associated with trans-femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness. Catheter Cardiovasc Interv 2020; 96:E369-E376. [PMID: 31794142 DOI: 10.1002/ccd.28620] [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: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR). OBJECTIVES Characterize the incidence, outcomes and predictors of ITC in a large cohort of transfemoral (TF) TAVR cases over a 5 year period. METHODS Retrospective registry and chart review of all nonclinical trial TF-TAVR patients from seven centers within one hospital system from 2012-2016. ITC were defined as cardiac perforation, new or worsening pericardial effusion/tamponade, annular rupture, thoracic aortic injury, aortic valve dislodgement, and coronary artery occlusion. Procedural and 30-day outcomes and 1-year mortality were compared between ITC and no ITC patients. Multivariable logistic regression was used to identify predictors of ITC. RESULTS Over the study period, 1,581 patients had TF-TAVR and 68 ITC occurred in 46 patients (2.9%). The most common ITCs were pericardial effusion/tamponade (59%), cardiac perforation (33%), and valve dislodgement (33%). ITC rate did not decline over time (rate (95% confidence interval) for 2012 = 0% (0-8.8%), 2013 = 1.3% (0-7.2%), 2014 = 4.4% (2.2-8.0%), 2015 = 3.5% (2.0-5.6%), and 2016 = 2.4% (1.5-3.8%)). ITC patients had worse 1-year survival (ITC: 60.7% (45.1-73.1%), no ITC: 88.7% (87.0-90.3%); p < .001). The majority of ITC patient deaths occurred within the first 30 days. Multivariable models to predict ITC were not successful. CONCLUSIONS ITC did not decline over time in our cohort. Predictors of ITC could not be identified. While these events are rare, they are associated with worse procedural outcomes and mortality. Heart teams should continue to be prepared for emergency intervention.
Collapse
Affiliation(s)
- Robert W Hodson
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon
| | - Ruyun Jin
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon
| | - Michael E Ring
- Providence Spokane Heart Institute, Providence St. Joseph Health, Spokane, Washington
| | - Sameer Gafoor
- Swedish Heart and Vascular Institute, Providence St. Joseph Health, Seattle, Washington
| | - Shawnna Verburg
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon
| | - Eric J Lehr
- Swedish Heart and Vascular Institute, Providence St. Joseph Health, Seattle, Washington
| | - Kateri J Spinelli
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon
| |
Collapse
|
18
|
Lehr EJ, Petersen JL. Invited Commentary. Ann Thorac Surg 2019; 109:1832-1833. [PMID: 31794739 DOI: 10.1016/j.athoracsur.2019.10.037] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
| | - John L Petersen
- Division of Cardiology, Swedish Heart and Vascular Institute, Seattle, Washington
| |
Collapse
|
19
|
Lehr EJ, Pulido JN. Invited Commentary. Ann Thorac Surg 2018; 106:783-784. [PMID: 29758206 DOI: 10.1016/j.athoracsur.2018.04.035] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Eric J Lehr
- Department of Cardiac Surgery, Swedish Heart & Vascular Institute, Swedish Medical Center, 1600 E Jefferson, Seattle, WA 98122.
| | - Juan Nicolas Pulido
- Department of Cardiac Surgery, Swedish Heart & Vascular Institute, Swedish Medical Center, Seattle, Washington
| |
Collapse
|
20
|
Lehr EJ, Guy TS, Smith RL, Grossi EA, Shemin RJ, Rodriguez E, Ailawadi G, Agnihotri AK, Fayers TM, Hargrove WC, Hummel BW, Khan JH, Malaisrie SC, Mehall JR, Murphy DA, Ryan WH, Salemi A, Segurola RJ, Smith JM, Wolfe JA, Weldner PW, Barnhart GR, Goldman SM, Lewis CTP. Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches. Innovations (Phila) 2017; 11:260-7. [PMID: 27662478 PMCID: PMC5051529 DOI: 10.1097/imi.0000000000000299] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.
Collapse
Affiliation(s)
- Eric J Lehr
- From the *Swedish Heart and Vascular Institute, Seattle, WA USA; †Temple University, Philadelphia, PA USA; ‡The Heart Hospital Baylor Plano, Plano, TX USA; §New York University School of Medicine, New York, NY USA; ∥David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA; ¶St. Thomas Hospital, Nashville, TN USA; #University of Virginia, Charlottesville, VA USA; **Saint Elizabeth's Medical Center, Brighton, MA USA; ††Holy Spirit Northside Hospital, Chermside, Australia; ‡‡Penn Presbyterian Medical Center, Philadelphia, PA USA; §§Gulf Coast Cardiothoracic & Vascular Surgeons, Ft. Myers, FL USA; ∥∥East Bay Cardiac Surgery Center, Oakland, CA USA; ¶¶Northwestern University, Feinberg School of Medicine, Chicago, IL USA; ##Penrose St. Francis Hospital, Colorado Springs, CO USA; ***Emory St. Joseph's Hospital, Atlanta, GA USA; †††Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY USA; ‡‡‡South Florida Heart & Lung Institute, Doral, FL USA; §§§TriHealth Heart Institute, Cincinnati, OH USA; ∥∥∥Northeast Georgia Physicians Group, Gainesville, GA USA; ¶¶¶Central Maine Heart and Vascular Institute, Lewiston, ME USA; ###Lankenau Medical Center, Wynnewood, PA USA; and ****Department of Cardiothoracic Surgery, Princeton Baptist Hospital, Birmingham, AL USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Gafoor S, Petrescu OM, Lehr EJ, Puls C, Zhang M, Petersen JL, Olsen JV, Penev I, Agrawal M, Sharma R, Barnhart G. Percutaneous Tricuspid Valve Regurgitation Repair With the MitraClip Device Using an Edge-to-Edge Bicuspidization Technique. J Invasive Cardiol 2017; 29:E30-E36. [PMID: 28255106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patients who present with both severe mitral and tricuspid regurgitation who are symptomatic despite optimal medical therapy and at prohibitive risk for surgery pose a significant therapeutic challenge. The MitraClip device (Abbott Vascular) is approved for percutaneous mitral valve repair in high-risk and non-operative patients, and has also been used for tricuspid valve repair. Imaging support for percutaneous edge-to-edge tricuspid valve repair has not been reported and is a vital part of the procedure. Here, we present a periprocedural imaging strategy for percutaneous tricuspid valve repair with the MitraClip device using a bicuspidization technique.
Collapse
Affiliation(s)
- Sameer Gafoor
- Department of Cardiology, Swedish Heart and Vascular Institute, Swedish Medical Center, 550 E. 17th Ave, Suite #680, Seattle, WA, 98122 USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Lehr EJ. Invited Commentary. Ann Thorac Surg 2016; 103:104-105. [PMID: 28007230 DOI: 10.1016/j.athoracsur.2016.06.065] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Eric J Lehr
- Cardiac Surgery Research and Education, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste #110, Seattle, WA98122.
| |
Collapse
|
23
|
Affiliation(s)
- Eric J Lehr
- Swedish Heart and Vascular Institute, Seattle, Wash.
| |
Collapse
|
24
|
Wolfe JA, Malaisrie SC, Farivar RS, Khan JH, Hargrove WC, Moront MG, Ryan WH, Ailawadi G, Agnihotri AK, Hummel BW, Fayers TM, Grossi EA, Guy TS, Lehr EJ, Mehall JR, Murphy DA, Rodriguez E, Salemi A, Segurola RJ, Shemin RJ, Smith JM, Smith RL, Weldner PW, Lewis CTP, Barnhart GR, Goldman SM. Minimally Invasive Mitral Valve Surgery II Surgical Technique and Postoperative Management. Innovations 2016. [DOI: 10.1177/155698451601100404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J. Alan Wolfe
- Northeast Georgia Physicians Group, Gainesville, GA USA
| | | | - R. Saeid Farivar
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN USA
| | | | | | | | | | | | | | - Brian W. Hummel
- Gulf Coast Cardiothoracic & Vascular Surgeons, Ft. Myers, FL USA
| | | | | | | | - Eric J. Lehr
- Swedish Heart and Vascular Institute, Seattle, WA USA
| | | | | | | | - Arash Salemi
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY USA
| | | | - Richard J. Shemin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | | | | | - Paul W. Weldner
- Central Maine Heart and Vascular Institute, Lewiston, ME USA
| | - Clifton T. P. Lewis
- Department of Cardiothoracic Surgery, Princeton Baptist Hospital, Birmingham, AL USA
| | | | | |
Collapse
|
25
|
Ailawadi G, Agnihotri AK, Mehall JR, Wolfe JA, Hummel BW, Fayers TM, Farivar RS, Grossi EA, Guy TS, Hargrove WC, Khan JH, Lehr EJ, Malaisrie SC, Murphy DA, Rodriguez E, Ryan WH, Salemi A, Segurola RJ, Shemin RJ, Smith JM, Smith RL, Weldner PW, Goldman SM, Lewis CTP, Barnhart GR. Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning. Innovations 2016. [DOI: 10.1177/155698451601100403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - J. Alan Wolfe
- Northeast Georgia Physicians Group, Gainesville, GA USA
| | - Brian W. Hummel
- Gulf Coast Cardiothoracic and Vascular Surgeons, Ft. Myers, FL USA
| | | | - R. Saeid Farivar
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN USA
| | | | | | | | | | - Eric J. Lehr
- Swedish Heart and Vascular Institute, Seattle, WA USA
| | | | | | | | | | - Arash Salemi
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY USA
| | | | - Richard J. Shemin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | | | | | - Paul W. Weldner
- Central Maine Heart and Vascular Institute, Lewiston, ME USA
| | | | - Clifton T. P. Lewis
- Department of Cardiothoracic Surgery, Princeton Baptist Hospital, Birmingham, AL USA
| | | |
Collapse
|
26
|
Lehr EJ, Guy TS, Smith RL, Grossi EA, Shemin RJ, Rodriguez E, Ailawadi G, Agnihotri AK, Fayers TM, Hargrove WC, Hummel BW, Khan JH, Malaisrie SC, Mehall JR, Murphy DA, Ryan WH, Salemi A, Segurola RJ, Smith JM, Wolfe JA, Weldner PW, Barnhart GR, Goldman SM, Lewis CTP. Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches. Innovations 2016. [DOI: 10.1177/155698451601100405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eric J. Lehr
- Swedish Heart and Vascular Institute, Seattle, WA USA
| | | | | | | | - Richard J. Shemin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | | | | | | | | | | | - Brian W. Hummel
- Gulf Coast Cardiothoracic & Vascular Surgeons, Ft. Myers, FL USA
| | | | | | | | | | | | - Arash Salemi
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY USA
| | | | | | - J. Alan Wolfe
- Northeast Georgia Physicians Group, Gainesville, GA USA
| | - Paul W. Weldner
- Central Maine Heart and Vascular Institute, Lewiston, ME USA
| | | | | | - Clifton T. P. Lewis
- Department of Cardiothoracic Surgery, Princeton Baptist Hospital, Birmingham, AL USA
| |
Collapse
|
27
|
Lehr EJ. Blazing the Trail for Robot-Assisted Cardiac Surgery. Ann Thorac Surg 2016; 102:1-3. [PMID: 27343489 DOI: 10.1016/j.athoracsur.2016.04.035] [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: 03/28/2016] [Revised: 03/28/2016] [Accepted: 04/01/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Eric J Lehr
- Swedish Heart and Vascular Institute, Seattle, Washington.
| |
Collapse
|
28
|
Chakravarthy A, Lehr EJ, Bindon SL. Caring for Patients with Totally Endoscopic Coronary Artery Bypass: Special Considerations for the ED Nurse. J Emerg Nurs 2016; 43:100-105. [PMID: 27264967 DOI: 10.1016/j.jen.2016.04.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022]
|
29
|
Youssef SJ, Millan JA, Youssef GM, Earnheart A, Lehr EJ, Barnhart GR. The Role of Computed Tomography Angiography in Patients Undergoing Evaluation for Minimally Invasive Cardiac Surgery: An Early Program Experience. Innovations 2015. [DOI: 10.1177/155698451501000105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Eric J. Lehr
- Swedish Heart & Vascular Institute and Medical Center, WA USA
| | | |
Collapse
|
30
|
Gibber M, Lehr EJ, Kon ZN, Wehman PB, Griffith BP, Bonatti J. Is There a Role for Robotic Totally Endoscopic Coronary Artery Bypass in Patients with a Colostomy? Innovations�(Phila) 2014; 9:448-50. [DOI: 10.1177/155698451400900610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.
Collapse
Affiliation(s)
- Marc Gibber
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Eric J. Lehr
- Swedish Heart and Vascular Institute, Seattle, WA USA
| | - Zachary N. Kon
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - P. Brody Wehman
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Bartley P. Griffith
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Johannes Bonatti
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH USA
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| |
Collapse
|
31
|
Likosky DS, Al-Attar PM, Malenka DJ, Furnary AP, Lehr EJ, Paone G, Kommareddi M, Helm R, Jin R, Maynard C, Hanson EC, Olmstead EM, Mackenzie TA, Ross CS, Zhang M. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2014; 148:3084-9. [PMID: 25227699 DOI: 10.1016/j.jtcvs.2014.07.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/27/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A number of established regional quality improvement collaboratives have partnered to assess and improve care across their regions under the umbrella of the Cardiac Surgery Quality Improvement (IMPROVE) Network. The first effort of the IMPROVE Network has been to assess regional differences in potentially discretionary transfusions (<3 units red blood cells [RBCs]). METHODS We examined 11,200 patients undergoing isolated nonemergent coronary artery bypass graft surgery across 56 medical centers in 4 IMPROVE Network regions between January 2008 and June 2012. Each center submitted the most recent 200 patients who received 0, 1, or 2 units of RBC transfusion during the index admission. Patient and disease characteristics, intraoperative practices, and percentage of patients receiving RBC transfusions were collected. Region-specific transfusion rates were calculated after adjusting for pre- and intraoperative factors among region-specific centers. RESULTS There were small but significant differences in patient case mix across regions. RBC transfusions of 1 or 2 units occurred among 25.2% of coronary artery bypass graft procedures (2826 out of 11,200). Significant variation in the number of RBC units used existed across regions (no units, 74.8% [min-max, 70.0%-84.1%], 1 unit, 9.7% [min-max, 5.1%-11.8%], 2 units, 15.5% [min-max, 9.1%-18.2%]; P < .001). Variation in overall transfusion rates remained after adjustment (9.1%-31.7%; P < .001). CONCLUSIONS Delivery of small volumes of RBC transfusions was common, yet varied across geographic regions. These data suggest that differences in regional practice environments, including transfusion triggers and anemia management, may contribute to variability in RBC transfusion rates.
Collapse
Affiliation(s)
- Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | | | - David J Malenka
- Departments of Medicine and The Dartmouth Institute for Health Care Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Eric J Lehr
- Swedish Heart and Vascular Institute, Seattle, Wash
| | - Gaetano Paone
- Division of Cardiac Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Mich
| | | | - Robert Helm
- Department of Surgery, Portsmouth Regional Hospital, Portsmouth, NH
| | - Ruyun Jin
- Medical Data Research Center, Providence Health and Services, Portland, Ore
| | | | - Eric C Hanson
- Department of Cardiovascular Surgery, Beaumont Hospital, Troy, Mich
| | - Elaine M Olmstead
- Departments of Medicine and The Dartmouth Institute for Health Care Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Todd A Mackenzie
- Departments of Medicine and The Dartmouth Institute for Health Care Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Cathy S Ross
- Departments of Medicine and The Dartmouth Institute for Health Care Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Min Zhang
- Department of Biostatistics, University of Michigan, Ann Arbor, Mich
| | | |
Collapse
|
32
|
Wehman B, Lehr EJ, Lahiji K, Lee JD, Kon ZN, Jeudy J, Griffith BP, Bonatti J. Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 2014; 19:572-6. [DOI: 10.1093/icvts/ivu226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Wiedemann D, Schachner T, Bonaros N, Lehr EJ, Wehman B, Hong P, Gibber M, Lee J, Bonatti J. Robotic Totally Endoscopic Coronary Artery Bypass Grafting in Men and Women: Are There Sex Differences in Outcome? Ann Thorac Surg 2013; 96:1643-7. [DOI: 10.1016/j.athoracsur.2013.05.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 05/21/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
|
34
|
Srivastava MC, Vesely MR, Lee JD, Lehr EJ, Wehman B, Bonaros N, Schachner T, Friedrich GJ, Zimrin DA, Bonatti JO. Robotically Assisted Hybrid Coronary Revascularization: Does Sequence of Intervention Matter? Innovations 2013. [DOI: 10.1177/155698451300800302] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mukta C. Srivastava
- Division of Cardiology, University of Maryland Medical Center, Baltimore, MD USA
| | - Mark R. Vesely
- Division of Cardiology, University of Maryland Medical Center, Baltimore, MD USA
| | - Jeffrey D. Lee
- Thoracic and Cardiovascular Surgery, the Cleveland Clinic, Cleveland, OH USA
| | - Eric J. Lehr
- Cardiac Surgery, Swedish Heart & Vascular Institute, Seattle, WA USA
| | - Brody Wehman
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD USA
| | - Nikolaos Bonaros
- Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Schachner
- Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Guy J. Friedrich
- Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - David A. Zimrin
- Division of Cardiology, University of Maryland Medical Center, Baltimore, MD USA
| | | |
Collapse
|
35
|
Lee JD, Bonaros N, Hong PT, Kofler M, Srivastava M, Herr DL, Lehr EJ, Bonatti J. Factors Influencing Hospital Length of Stay After Robotic Totally Endoscopic Coronary Artery Bypass Grafting. Ann Thorac Surg 2013; 95:813-8. [DOI: 10.1016/j.athoracsur.2012.10.087] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
|
36
|
Lehr EJ. Invited commentary. Ann Thorac Surg 2013; 95:605. [PMID: 23336872 DOI: 10.1016/j.athoracsur.2012.08.069] [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: 08/20/2012] [Revised: 08/20/2012] [Accepted: 08/30/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste #110, Seattle, WA 98122, USA.
| |
Collapse
|
37
|
Bonatti J, Wehman B, de Biasi AR, Jeudy J, Griffith B, Lehr EJ. Totally Endoscopic Quadruple Coronary Artery Bypass Grafting Is Feasible Using Robotic Technology. Ann Thorac Surg 2012; 93:e111-2. [DOI: 10.1016/j.athoracsur.2011.11.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/03/2011] [Accepted: 11/14/2011] [Indexed: 12/01/2022]
|
38
|
Stevens LM, Rodriguez E, Lehr EJ, Kindell LC, Nifong LW, Ferguson TB, Chitwood WR. Impact of Timing and Surgical Approach on Outcomes After Mitral Valve Regurgitation Operations. Ann Thorac Surg 2012; 93:1462-8. [DOI: 10.1016/j.athoracsur.2012.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/06/2011] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
|
39
|
Wiedemann D, Bonaros N, Schachner T, Weidinger F, Lehr EJ, Vesely M, Bonatti J. Surgical problems and complex procedures: Issues for operative time in robotic totally endoscopic coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 143:639-647.e2. [DOI: 10.1016/j.jtcvs.2011.04.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/05/2011] [Accepted: 04/26/2011] [Indexed: 11/26/2022]
|
40
|
Song Z, Lehr EJ, Wang S. An alternative subcoronary implantation technique decreases the risk of complete heart block after stentless aortic valve replacement. J Cardiovasc Dis Res 2012; 3:46-51. [PMID: 22346147 PMCID: PMC3271683 DOI: 10.4103/0975-3583.91594] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Context: Stentless aortic valve prostheses have excellent hemodynamic profiles, but may be associated with an increased postoperative heart block when compared to conventional prostheses. Aims: To assess the effect of an alternative subcoronary implantation technique on postoperative complete heart block (CHB) and permanent pacemaker implantation (PPI) following aortic valve replacement (AVR) with stentless tissue valves. Settings and Design: A total of 130 consecutive patients undergoing AVR with stentless tissue valves by a single surgeon were studied retrospectively. Materials and Methods: A stentless tissue valve was implanted into 80 patients using the conventional modified subcoronary implantation technique, and 50 patients received a stentless tissue valve by an alternative subcoronary technique in which the inflow suture line is raised at the level of right-non coronary commissure. Data were collected at the time of hospital discharge and at 6–12 months postoperatively. Statistical Analysis Used: Independent samples t-test was used to compare continuous variables, and categorical variables were compared with the chi-square test. Results: Use of this new method reduced postoperative CHB (4.0% vs. 16.3%, P = 0.033), with fewer patients requiring PPI in the early postoperative period (6.0% vs. 18.8%, P = 0.041). Echocardiographic examination showed no differences in the effective orifice area, peak and mean aortic valve gradients, or left ventricular mass index between groups. Trivial or mild aortic regurgitation was found in 3.9% of patients with the conventional modified technique and 4.0% of patients undergoing the alternative technique, during follow-up (P > 0.05). Conclusions: Compared to the conventional subcoronary implantation technique, the alternative subcoronary implantation technique reduces the incidence of new CHB and the requirement of PPI following AVR with stentless tissue valves while preserving mid-term hemodynamic function.
Collapse
Affiliation(s)
- Zhigang Song
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | | | | |
Collapse
|
41
|
Bonatti J, Lee JD, Bonaros N, Schachner T, Lehr EJ. Robotic Totally Endoscopic Multivessel Coronary Artery Bypass Grafting Procedure Development, Challenges, Results. Innovations 2012. [DOI: 10.1177/155698451200700102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Johannes Bonatti
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Jeffrey D. Lee
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Nikolaos Bonaros
- †University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Schachner
- †University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Eric J. Lehr
- ‡Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA USA
| |
Collapse
|
42
|
Dawood MY, Lehr EJ, de Biasi A, Haque R, Grigore A, Griffith BP, Bonatti JO. Robotically Assisted Coronary Endarterectomy. Innovations 2011. [DOI: 10.1177/155698451100600610] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Murtaza Y. Dawood
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Eric J. Lehr
- Swedish Heart and Vascular Institute, Seattle, WA USA
| | - Andreas de Biasi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Reyaz Haque
- Division of Cardiology, and Department of Anesthesia, Baltimore, MD USA
| | - Alina Grigore
- Department of Anesthesia, University of Maryland School of Medicine, Baltimore, MD USA
| | - Bartley P. Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Johannes O. Bonatti
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| |
Collapse
|
43
|
Affiliation(s)
- Johannes Bonatti
- Department of Surgery, Division of Cardiac Surgery, University of Maryland at Baltimore, 22 S Greene St, N4W94, Baltimore, MD 21201, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Gammie JS, Lehr EJ, Griffith BP, Dawood MY, Bonatti J. Robotic-Assisted Aortic Valve Bypass (Apicoaortic Conduit) for Aortic Stenosis. Ann Thorac Surg 2011; 92:726-8. [DOI: 10.1016/j.athoracsur.2011.01.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/29/2010] [Accepted: 01/27/2011] [Indexed: 11/17/2022]
|
45
|
Lehr EJ, Wang PZT, Oreopoulos A, Kanji H, Norris C, Macarthur R. Midterm outcomes and quality of life of aortic root replacement: mechanical vs biological conduits. Can J Cardiol 2011; 27:262.e15-20. [PMID: 21459276 DOI: 10.1016/j.cjca.2010.12.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/05/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Aortic root replacement is a complex operation for severe aortic root pathology such as aneurysms and dissections with concomitant aortic valve disease. Biological and mechanical valve conduits are available. METHODS Early and midterm results were analyzed in patients undergoing aortic root replacement. From January 1, 1998, to May 31, 2007, 144 patients underwent aortic root replacement (Bentall procedures) with either a mechanical (n = 51) or a biological (n = 93) valve conduit. Cox proportional hazard analysis was used to determine whether valve type was an independent predictor of all-cause mortality, and analysis of covariance was used to compare general and disease-specific health-related quality-of-life scores. RESULTS Operative mortality was 2.1%. Median follow-up time was 40 months; 1- and 5-year survival rates for the mechanical group were 96.0% and 89.0%, respectively, vs 93.0% and 84.0% for the biological group. Valve type was not predictive of all-cause mortality, and valve-related complications were not significantly different between groups. At follow-up, 31.5% of patients in the biological group were on anticoagulant. General and disease-specific health-related quality-of-life scores were not significantly different between groups. CONCLUSIONS Aortic root replacement with either mechanical or biological valved conduits is a safe procedure. Morbidity, mortality, and adverse quality of life were not associated with the type of valve conduit. Further studies are required to assess long-term durability of biological valve conduits used for aortic root replacement.
Collapse
Affiliation(s)
- Eric J Lehr
- The University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
46
|
Schachner T, Bonaros N, Wiedemann D, Lehr EJ, Weidinger F, Feuchtner G, Zimrin D, Bonatti J. Predictors, causes, and consequences of conversions in robotically enhanced totally endoscopic coronary artery bypass graft surgery. Ann Thorac Surg 2011; 91:647-53. [PMID: 21352972 DOI: 10.1016/j.athoracsur.2010.10.072] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/24/2010] [Accepted: 10/26/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Totally endoscopic coronary artery bypass graft surgery (TECAB), using the da Vinci telemanipulator, has become a reproducible operation at dedicated centers. As in every endoscopic operation, conversion is an important and probably inevitable issue. METHODS We performed robotic TECAB in 326 patients (age, 60 years; range, 31 to 90 years); 242 were single-vessel and 84 were multivessel TECAB. RESULTS Forty-six of 326 patients (14%) were converted to a larger incision (minithoracotomy, n = 5; sternotomy, n = 41). Left internal mammary artery injury (n = 7), epicardial injury (n = 4), balloon endoocclusion problems (n = 7), and anastomotic problems (n = 18) were common reasons for conversions. Conversion rate was significantly less for single-vessel versus multivessel TECABs (10% versus 25%; p = 0.001). Non-learning-curve case (7% versus 21%; p < 0.001) and transthoracic assistance (11% versus 22%; p = 0.018) were associated with lower conversion rates. In multivariate analysis, learning-curve case was the only independent predictor of conversion (p = 0.005). Conversion translated into increased packed red blood cell transfusion in the operating room (3 versus 0 units; p < 0.001), longer ventilation time (14 versus 8 hours; p < 0.001), and intensive care unit stay (45 versus 20 hours; p = 0.001). Hospital mortality was 0.6% in this series, with 1 patient in the conversion group (2.2%) and 1 patient in the nonconverted group (0.4%; not significant). Five-year survival was 98% in nonconverted patients and 88% in converted patients (p = 0.018). There was no difference in freedom from angina or freedom from major adverse cardiac and cerebral events. CONCLUSIONS Conversion in TECAB is primarily learning curve-dependent and associated with increased morbidity, but does not significantly affect hospital mortality. Both nonconverted and converted patients show good long-term survival, which is comparable to patients undergoing open sternotomy coronary artery bypass grafting. Long-term freedom from angina or freedom from major adverse cardiac and cerebral events is not influenced by conversion.
Collapse
Affiliation(s)
- Thomas Schachner
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Lehr EJ, Rodriguez E, Stevens LM, Nifong LW, Chitwood WR. Robotic-Assisted Cryosurgical Treatment of Atrioventricular Node Reentrant Tachycardia. Innovations 2011. [DOI: 10.1177/155698451100600209] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric J. Lehr
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD USA
| | - Evelio Rodriguez
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Greenville, NC USA
| | - Louis-Mathieu Stevens
- Cardiac Surgery Division, Centre Hospitalier Universitaire de Montréal, Montréal, QC Canada
| | - L. Wiley Nifong
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Greenville, NC USA
| | - W. Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Greenville, NC USA
| |
Collapse
|
48
|
|
49
|
Zimrin D, Bonatti J, Vesely MR, Lehr EJ. Hybrid Coronary Revascularization: An Overview of Options for Anticoagulation and Platelet Inhibition. Heart Surg Forum 2010; 13:E405-8. [DOI: 10.1532/hsf98.20101157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
50
|
Lehr EJ, Alford TJ, Wang SH. Recombinant Activated Factor VII for Postoperative Hemorrhage Following Repair of Acute Type A Aortic Dissection. Heart Surg Forum 2010; 13:E275-9. [DOI: 10.1532/hsf98.20101027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|