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Hasan I, Roselli E, Sultan I. Discussion to: Lower extremity malperfusion syndrome in patients undergoing proximal aortic surgery for acute type A aortic dissection. JTCVS Open 2023; 15:14-15. [PMID: 37808030 PMCID: PMC10556931 DOI: 10.1016/j.xjon.2023.07.014] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Irsa Hasan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Eric Roselli
- Cardiac Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Center for Thoracic Aortic Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Desai MY, Xu S, Ospina S, Mentias AG, Bittel BA, Thamilarasan M, Roselli E, Svensson LG, Kalahasti V, Zheng W, Vargo P, Halim HA. A PROSPECTIVE STUDY TO ASSESS MULTI-DOMAIN PATIENT REPORTED CARDIAC QUALITY OF LIFE IN THORACIC AORTOPATHY: RESULTS FROM ULPLIFT-TA STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02547-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Steck D, Keshavamurthy S, Kumar A, Lyden S, Roselli E. Stent Migration Following Endovascular Intervention in May-Thurner Syndrome. Cureus 2022. [DOI: 10.7759/cureus.r63] [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: 11/07/2022] Open
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Keshavamurthy S, Duncan A, Kumar A, Trombetta C, Rodriguez R, Tan C, Roselli E. Double Valve Replacement in a Patient With Hunter Syndrome. Cureus 2022; 14:e28961. [PMID: 36237781 PMCID: PMC9547770 DOI: 10.7759/cureus.28961] [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] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
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Steck D, Keshavamurthy S, Kumar A, Lyden S, Roselli E. Stent Migration Following Endovascular Intervention in May-Thurner Syndrome. Cureus 2022; 14:e29714. [PMID: 38348159 PMCID: PMC10860737 DOI: 10.7759/cureus.29714] [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] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Developments in endovascular therapies have made stenting a common practice in the treatment of peripheral vascular diseases, including venous disorders such as May-Thurner syndrome. The placement of a stent in the venous system carries the risk of stent migration which although small occurs with a 3% incidence rate and can be life-threatening given the risk of pulmonary infarction, tricuspid regurgitation, and right-sided heart failure. Herein we report a case of stent embolization from the common iliac vein into the right side of the heart causing tricuspid regurgitation. After the failure of percutaneous approach to retrieve the stent, it was successfully removed using a minimally invasive right thoracotomy approach along with repair of the tricuspid valve.
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Affiliation(s)
- Dominick Steck
- Surgery, University of Washington School of Medicine, Seattle, USA
| | | | - Akshay Kumar
- Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, USA
| | - Sean Lyden
- Vascular Surgery, Cleveland Clinic Foundation, Cleveland, USA
| | - Eric Roselli
- Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, USA
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Gad MM, Lichtman D, Saad AM, Isogai T, Bansal A, Abdallah MS, Roselli E, Chatterjee S, Reed GW, Kapadia SR, Menon V, Wassif H. Autoimmune connective tissue diseases and aortic valve replacement outcomes: a population-based study. European Heart Journal Open 2022; 2:oeac024. [PMID: 35919348 PMCID: PMC9242052 DOI: 10.1093/ehjopen/oeac024] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/26/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Patients with autoimmune connective tissue diseases (CTDs) have a high burden of valvular heart disease and are often thought of as high surgical risk patients.
Methods and results
Patients undergoing aortic valve replacement (AVR) were identified in the Nationwide Readmissions Database between January 2012 and December 2018. Patients with a history of systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed C, Sjögren syndrome, polymyositis, and dermatomyositis were included in the CTD cohort. Patients undergoing coronary artery bypass grafting concomitantly with AVR were excluded. A total of 569 600 hospitalizations were included, of which16 531 (2.9%) had CTD. CTD patients were more likely to be females, with higher rates of heart failure, pulmonary hypertension, and more likely to be insured by Medicare. CTD patients had lower mortality than non-CTD patients [odds ratio (OR) 0.66; 95% confidence interval (CI): 0.59–0.74] and stroke [OR 0.87; 95% (CI): 0.79–0.97]. CTD patients undergoing SAVR had lower mortality [OR 0.69; 95% (CI): 0.60–0.80] and stroke [OR 0.86; 95% (CI): 0.75–0.98). CTD patients undergoing TAVR had lower mortality outcomes [OR 0.67; 95% (CI): 0.56–0.80]; however, they had comparable stroke outcomes [OR 0.97; 95% (CI): 0.83–1.13, P = 0.69].
Conclusions
Outcomes for patients with CTD requiring AVR are not inferior to their non-CTD counterparts. A comprehensive heart team selection of patients undergoing AVR approaches should place CTD history under consideration; however, pre-existing CTD should not be prohibitive of AVR interventions.
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Affiliation(s)
- Mohamed M. Gad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
- Gillings School of Global Public Health, the University of North Carolina at Chapel Hill , Chapel Hill, NC 27599, USA
| | - Devora Lichtman
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Anas M. Saad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Agam Bansal
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Mouin S. Abdallah
- Department of Cardiology, Medstar Heart and Vascular Institute , Fairfax, VA 22031, USA
| | - Eric Roselli
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Soumya Chatterjee
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
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Francalanci M, Taccetti G, Fevola C, Di Rosa G, Cavicchi M, Galici V, Neri A, Terlizzi V, Bianchimani C, Campana S, Dolce D, Marchi C, Ravenni N, Camera E, Pierattini V, Roselli E. P164 Nutritional status and circulating levels of fat-soluble vitamins in cystic fibrosis: cross-sectional analysis and effect of elexacaftor/tezacaftor/ivacaftor. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00495-7] [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: 10/18/2022]
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Lorusso R, Jiritano F, Roselli E, Shrestha M, Folliguet T, Meuris B, Pollari F, Fischlein T. Perioperative platelet reduction after sutureless or stented valve implantation: results from the PERSIST-AVR controlled randomized trial. Eur J Cardiothorac Surg 2021; 60:1359-1365. [PMID: 34118150 DOI: 10.1093/ejcts/ezab175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/04/2020] [Revised: 02/19/2021] [Accepted: 02/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Platelet count reduction is a common but not fully understood phenomenon after aortic valve replacement (AVR) with bioprosthesis implantation. The aim of the present study was to investigate the occurrence and the clinical impact of platelet count reduction in patients receiving the Perceval bioprosthesis compared to those receiving standard sutured stented bioprosthetic aortic valve in a randomized, controlled AVR study. METHODS PERceval Sutureless Implant versus STandard Aortic Valve Replacement is a prospective, randomized, adaptive, open-label trial. Patients were randomized (March 2016-September 2018) to AVR with a sutureless or stented valve. Ad hoc analyses have been performed to evaluate the occurrence of platelet count reduction and the clinical impact of the platelet variations in the 2 groups. RESULTS The Perceval group showed a higher platelet reduction than the control group (46% vs 32%). The phenomenon was transient in both groups, with a slow recovery of the platelet count by hospital discharge. No differences were observed between groups regarding need of transfusions, blood loss, major bleeding and stroke events. CONCLUSIONS The Perceval sutureless aortic bioprosthesis implantation is associated with higher rate of transient platelet reduction as compared to stented bioprostheses for AVR. However, the platelet count reduction is transient and the decline does not affect the patient's clinical outcomes. Current explanations for this phenomenon are speculative, and further investigations are required to elucidate it. CLINICAL TRIAL REGISTRATION NUMBER NCT02673697-ClinicalTrials.gov-4 February 2016.
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Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Federica Jiritano
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Eric Roselli
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpital Henri Mondor, Université Paris 12, Créteil, Paris, France
| | - Bart Meuris
- Cardiac Surgery Department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Francesco Pollari
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
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Geube M, Sale S, Bakdash S, Rajeswaran J, Roselli E, Blackstone E, Johnston D. Prepump autologous blood collection is associated with reduced intraoperative transfusions in aortic surgery with circulatory arrest: A propensity score-matched analysis. J Thorac Cardiovasc Surg 2021; 164:1572-1580.e5. [PMID: 33610366 DOI: 10.1016/j.jtcvs.2021.01.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effect of autologous whole blood (AWB) collection on intraoperative/postoperative allogeneic blood transfusion rate in complex aortic surgery with hypothermic circulatory arrest. METHODS This retrospective study included adults who underwent aortic surgery with hypothermic circulatory arrest at a single institution between 2014 and 2019. Out of 509 cases (414 patients), 110 (22%) received the AWB protocol. We performed propensity-score matching, including 35 preoperative and procedural variables, which resulted in 95 well-matched pairs, to compare outcomes in patients who received AWB protocol versus those who did not. Study outcomes were percentage of patients who received transfusion of allogeneic blood products intraoperatively and postoperatively. RESULTS Mean volume of collected autologous blood was 826 ± 263 mL. Intraoperatively, fewer AWB patients received red blood cell concentrate (33% vs 49%; P = .02), plasma (35% vs 62%; P = .0002), platelets (61% vs 81%; P = .003), and cryoprecipitate (43% vs 56%; P = .08) compared with non-AWB patients. During the entire hospital stay, the differences in transfusion rate between the 2 groups were: red blood cells (58% vs 62%; P = .6), plasma (49% vs 66%; P = .01), platelets (72% vs 82%; P = .09), and cryoprecipitate (56% vs 63%; P = .3). CONCLUSIONS Pre-pump autologous blood collection may reduce the need for intraoperative transfusion of allogenic non-red-cell blood products in patients undergoing complex aortic surgery with hypothermic circulatory arrest. A larger study is needed to clarify the influence of this association on patient outcomes and resource utilization.
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Affiliation(s)
- Mariya Geube
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio.
| | - Shiva Sale
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Suzanne Bakdash
- Department of Clinical Pathology, Division of Transfusion Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric Roselli
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eugene Blackstone
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Douglas Johnston
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio
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11
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Alviar CL, Gutierrez A, Cho L, Krishnaswamy A, Saleh A, Lincoff MA, Roselli E, Militello M, Menon V. Clevidipine as a therapeutic and cost-effective alternative to sodium nitroprusside in patients with acute aortic syndromes. European Heart Journal. Acute Cardiovascular Care 2020; 9:S5-S12. [DOI: 10.1177/2048872618777919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Sodium nitroprusside is the preferred agent for the treatment of high blood pressure during acute aortic syndrome if blood pressure remains elevated after heart rate control with beta-blockers. The increasing cost of sodium nitroprusside in the USA led us to assess the efficacy and safety of intravenous clevidipine, a calcium channel blocker with quick onset of action, short half-life and significantly lower costs than sodium nitroprusside, in patients presenting with acute aortic syndrome.
Methods:
We performed a retrospective chart review of consecutive patients admitted to the Cleveland Clinic Cardiac Intensive Care Unit from 2013–2016 with a diagnosis of acute aortic syndrome. Patients who received intravenous sodium nitroprusside were compared with those receiving intravenous clevidipine. The primary outcome was a significant difference in blood pressure at one, three and six hours. Secondary outcomes included time to achieving blood pressure target and in hospital mortality with rates of hypotension and bradycardia as safety endpoints.
Results:
A total of 85 patients with suspected acute aortic pathology received clevidipine and 50 received sodium nitroprusside. Clinical and demographic characteristics were similar in both groups, except for a higher incidence of abdominal aortic aneurysm in the clevidipine group and for a trend towards higher use of labetalol in the clevidipine group. There were no significant differences in blood pressure or heart rate at one, three and six hours after starting either infusion. The rates of hypotension, bradycardia and in-hospital mortality did not differ. Time to achieve blood pressure control were also similar between groups.
Conclusion:
Intravenous clevidipine appears to be a safe and effective alternative to sodium nitroprusside for the management of high blood pressure during acute aortic dissection. In the USA, clevidipine could represent a cost effective therapy providing similar outcomes than sodium nitroprusside.
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Affiliation(s)
- Carlos L Alviar
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
- Division of Cardiovascular Medicine, University of Florida, USA
| | | | - Leslie Cho
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
| | | | - Amr Saleh
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
| | | | - Eric Roselli
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
| | | | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic Foundation, USA
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Lak HM, Shah R, Verma BR, Roselli E, Caputo F, Xu B. Coronary Subclavian Steal Syndrome: A Contemporary Review. Cardiology 2020; 145:601-607. [PMID: 32653884 DOI: 10.1159/000508652] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
Coronary subclavian steal syndrome (CSSS) is a rare cause of angina. It occurs in patients with prior coronary artery bypass grafting and, specifically, a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft and co-existent significant subclavian artery stenosis. In this context, there is retrograde blood flow through the LIMA to LAD graft to supply the subclavian artery beyond the significant stenosis. This potentially occurs at the cost of compromising coronary artery perfusion dependent on the LIMA graft. In this review, we present a case of a middle-aged female who suffered from CSSS and review the literature for the contemporary diagnosis and management of this condition.
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Affiliation(s)
- Hassan M Lak
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rohan Shah
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Rai Verma
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francis Caputo
- Department of Vascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bo Xu
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA, .,Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA,
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Argalious MY, Steib J, Daskalakis N, Mao G, Li M, Armanyous S, Roselli E. Association of Testosterone Replacement Therapy and the Incidence of a Composite of Postoperative In-Hospital Mortality and Cardiovascular Events in Men Undergoing Cardiac Surgery. Anesth Analg 2020; 130:890-898. [DOI: 10.1213/ane.0000000000004115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Saijo Y, Isaza N, Conic JZ, Johnston D, Roselli E, Desai MY, Grimm RA, Svensson LG, Griffin BP, Popovic ZB. LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN PREDICTS RISK IN PATIENTS WITH MIXED AORTIC VALVE DISEASE: EVIDENCE FOR A CUT-OFF POINT. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32177-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pasadyn S, Roselli E, Artis A, Phelan D, Blackstone E. ACUTE TYPE A AORTIC DISSECTION: PHYSICIAN EXERCISE RESTRICTION VARIABILITY POST-REPAIR AND PATIENT INVOLVEMENT IN THOSE DECISIONS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33643-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sarac B, Mentias A, Raeisi-Giglou P, Hodges K, Popovic Z, Thamilarasan M, Lever H, Roselli E, Smedira N, Desai M. AORTIC ROOT/ASCENDING AORTOPATHY IN HYPERTROPHIC CARDIOMYOPATHY PATIENTS UNDERGOING CARDIAC MAGNETIC RESONANCE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31389-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lorusso R, Folliguet T, Shrestha M, Meuris B, Kappetein AP, Roselli E, Klersy C, Nozza M, Verhees L, Larracas C, Goisis G, Fischlein T. Sutureless versus Stented Bioprostheses for Aortic Valve Replacement: The Randomized PERSIST-AVR Study Design. Thorac Cardiovasc Surg 2018; 68:114-123. [DOI: 10.1055/s-0038-1675847] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abstract
Introduction Sutureless biological valves for surgical aortic valve replacement (SAVR), characterized by the absence of anchoring sutures at the aortic annulus, are gaining popularity because of ease and reproducibility of implant, shorter operating times, and enhancement of minimally invasive approaches. The stentless configuration of the sutureless valve was designed to achieve optimal hemodynamic performance.
Materials and Methods PERSIST-AVR (PERceval Sutureless Implant versus STandard Aortic Valve Replacement) is a prospective, randomized, adaptive, open-label, international, postmarket trial (NCT02673697). The primary objective of the trial is to assess the safety and efficacy of the Perceval (LivaNova, London, UK) sutureless bioprosthesis among patients undergoing SAVR in the presence of severe aortic stenosis to demonstrate the noninferiority of Perceval as compared with standard sutured stented bioprosthetic aortic valve as an isolated procedure or combined with coronary artery bypass grafting. Sample size will be determined adaptively through interim analyses performed by an Independent Statistical Unit till a maximum of 1,234 patients, enrolled at ∼60 sites in countries where the device is commercially available. Patients will be followed up for 5 years after implant. The primary end point is the number of patients free from major adverse cardiac and cerebrovascular-related events at 1 year. Additional secondary outcomes will be assessed up to 5 years.
Discussion PERSIST-AVR is the first prospective, randomized study comparing in-hospital and postdischarge outcomes in a robust population of patients undergoing SAVR with either the Perceval sutureless bioprosthesis or a conventional sutured stented bioprosthesis up to 5 years.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC + ), Maastricht, The Netherlands
| | - Thierry Folliguet
- Chirurgie Cardiaque & Transplantation, Assistance Publique, Hôpital, Henri Mondor, Université Paris 12 UPEC, France
| | - Malakh Shrestha
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bart Meuris
- Cardiac Surgery Department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | | | - Eric Roselli
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Catherine Klersy
- Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | | | | | | | | | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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Procop GW, Eng C, Clifford A, Villa-Forte A, Calabrese LH, Roselli E, Svensson L, Johnston D, Pettersson G, Soltesz E, Lystad L, Perry JD, Blandford A, Wilson DA, Hoffman GS. Varicella Zoster Virus and Large Vessel Vasculitis, the Absence of an Association. Pathog Immun 2017; 2:228-238. [PMID: 28758156 PMCID: PMC5531613 DOI: 10.20411/pai.v2i2.196] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/23/2022] Open
Abstract
Objective: It is controversial whether microorganisms play a role in the pathogenesis of large and medium vessel vasculitides (eg, giant cell arteritis [GCA], Takayasu arteritis [TAK] and focal idiopathic aortitis [FIA]). Recent studies have reported the presence of Varicella Zoster Virus (VZV) within formalin-fixed, paraffin-embedded temporal arteries and aortas of about three-quarters or more of patients with these conditions, and in a minority of controls. In a prospective study, we sought to confirm these findings using DNA extracted from vessels that were harvested under surgically aseptic conditions and snap frozen. Methods and Results: DNA samples extracted from 11 surgically sterile temporal arteries and 31 surgically sterile thoracic aortas were used in an attempt to identify the vessel-associated VZV genome. Two different validated PCR methods were used. Thirty-one thoracic aorta aneurysm specimens included biopsies from 8 patients with GCA, 2 from patients with TAK, 6 from patients with FIA, and 15 from patients without vasculitis, who had non-inflammatory aneurysms. Eleven temporal artery biopsies were collected from 5 patients with GCA and 6 controls. The presence of VZV was not identified in either the specimens from patients with large vessel vasculitis or from the controls. Conclusions: Using surgically sterile snap-frozen specimens, we were unable to confirm recent reports of the presence of VZV in either aortas or temporal arteries from patients with large vessel vasculitis or controls.
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Affiliation(s)
- Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alison Clifford
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio.,Division of Rheumatology, University of Alberta, Canada
| | - Alexandra Villa-Forte
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Leonard H Calabrese
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Eric Roselli
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Edward Soltesz
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lisa Lystad
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Deborah A Wilson
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary S Hoffman
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Alviar CL, Gutierrez A, Cho L, Krishnaswamy A, Saleh A, Lincoff A, Roselli E, Militello M, Menon V. CLEVEDIPINE AS A THERAPEUTIC AND COST-EFFECTIVE ALTERNATIVE TO SODIUM NITROPRUSSIDE IN PATIENTS WITH AORTIC DISSECTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35461-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Loor G, Doud A, Nguyen TC, Antonoff MB, Morancy JD, Robich MP, Odell DD, Yarboro LT, Vaporciyan AA, Roselli E. Development and Evaluation of a Three-Dimensional Multistation Cardiovascular Simulator. Ann Thorac Surg 2016; 102:62-8. [PMID: 27021029 DOI: 10.1016/j.athoracsur.2015.12.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 08/18/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND To facilitate deliberate practice, we developed and evaluated a three-dimensional multistation cardiovascular simulator with low-fidelity, anatomically correct materials. METHODS Surgical educators and senior fellows at several national institutions who are a part of the Thoracic Education Cooperative Group completed expert validation surveys that feature a self-report rating scale, ranging from 0 (don't know) to 4 (highly realistic, no changes needed), and a global recommendation rating scale, ranging from 0 to 3. To analyze the survey results, we used paired Student t tests and a many-facet Rasch model. RESULTS We analyzed the results of 18 expert validation surveys (completed by 9 senior fellows and by 9 staff surgeons). The overall realism-of-experience rating for the simulator was 3.23 (of 4), suggesting adequate realism with room remaining for improvement. Senior fellows rated the aortic graft replacement station and overall physical attributes more favorably than staff. Staff surgeons favored the simulator for realism of the mitral valve annuloplasty station and the cannulation station and for its use as a training tool. The overall global recommendation rating for the simulator was 2.38 (of 3), suggesting that the simulator can be considered for use in cardiovascular surgery training programs with minor improvements. CONCLUSIONS This three-dimensional multistation cardiovascular simulator has adequate realism and can be considered for use in cardiovascular training programs. Platforms such as this may facilitate deliberate home practice and reinforcement of technical skills.
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Affiliation(s)
- Gabriel Loor
- Department of Surgery, University of Minnesota Health, Minneapolis, Minnesota.
| | - Alexander Doud
- Department of Surgery, University of Minnesota Health, Minneapolis, Minnesota
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean D Morancy
- Department of Surgery, University of Minnesota Health, Minneapolis, Minnesota
| | - Michael P Robich
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - David D Odell
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Leora T Yarboro
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Deshmukh A, Barnard J, Sun H, Newton D, Castel L, Pettersson G, Johnston D, Roselli E, Gillinov AM, McCurry K, Moravec C, Smith JD, Van Wagoner DR, Chung MK. Left atrial transcriptional changes associated with atrial fibrillation susceptibility and persistence. Circ Arrhythm Electrophysiol 2014; 8:32-41. [PMID: 25523945 DOI: 10.1161/circep.114.001632] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prior transcriptional studies of atrial fibrillation (AF) have been limited to specific transcripts, animal models, chronic AF, right atria, or small samples. We sought to characterize the left atrial transcriptome in human AF to distinguish changes related to AF susceptibility and persistence. METHODS AND RESULTS Left atrial appendages from 239 patients stratified by coronary artery disease, valve disease, and AF history (no history of AF, AF history in sinus rhythm at surgery, and AF history in AF at surgery) were selected for genome-wide mRNA microarray profiling. Transcripts were examined for differential expression with AF phenotype group. Enrichment in differentially expressed genes was examined in 3 gene set collections: a transcription factor collection, defined by shared conserved cis-regulatory motifs, a miRNA collection, defined by shared 3' untranslated region motifs, and a molecular function collection, defined by shared Gene Ontology molecular function. AF susceptibility was associated with decreased expression of the targets of CREB/ATF family, heat-shock factor 1, ATF6, SRF, and E2F1 transcription factors. Persistent AF activity was associated with decreased expression in genes and gene sets related to ion channel function consistent with reported functional changes. CONCLUSIONS AF susceptibility was associated with decreased expression of targets of several transcription factors related to inflammation, oxidation, and cellular stress responses. In contrast, changes in ion channel expression were associated with AF activity but were limited in AF susceptibility. Our results suggest that significant transcriptional remodeling marks susceptibility to AF, whereas remodeling of ion channel expression occurs later in the progression or as a consequence of AF.
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Affiliation(s)
- Amrish Deshmukh
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - John Barnard
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Han Sun
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - David Newton
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Laurie Castel
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Gosta Pettersson
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Douglas Johnston
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Eric Roselli
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - A Marc Gillinov
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Kenneth McCurry
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Christine Moravec
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Jonathan D Smith
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - David R Van Wagoner
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Mina K Chung
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.).
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Svensson LG, Roselli E. Invited commentary. Ann Thorac Surg 2014; 98:2090-1. [PMID: 25468086 DOI: 10.1016/j.athoracsur.2014.08.004] [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: 08/01/2014] [Revised: 08/01/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Lars G Svensson
- Aortic Center, Cleveland Clinic, 9500 Euclid Ave, J4-1, Cleveland, OH44195.
| | - Eric Roselli
- Aortic Center, Cleveland Clinic, 9500 Euclid Ave, J4-1, Cleveland, OH44195
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Heimansohn D, Roselli E, Thourani V, Wang S, Voisine P, Ye J, Dabir R, Moon M. 339 * NORTH AMERICAN FDA TRIAL RESULTS AT ONE YEAR OF THE SORIN(R) FREEDOM SOLO PERICARDIAL AORTIC VALVE. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.339] [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: 11/14/2022] Open
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Vivacqua A, Idrees J, Johnston DR, Soltesz E, Svensson L, Roselli E. 005 * STENTGRAFT FIRST STAGED REPAIR OF TYPE 2 THORACO-ABDOMINAL ANEURYSM: THE ENDOVASCULAR ELEPHANT TRUNK. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.5] [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: 11/12/2022] Open
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Aggarwal B, Raymond CE, Randhawa MS, Roselli E, Jacob J, Eagleton M, Kralovic DM, Kormos K, Holloway D, Menon V. Transfer Metrics in Patients With Suspected Acute Aortic Syndrome. Circ Cardiovasc Qual Outcomes 2014; 7:780-2. [DOI: 10.1161/circoutcomes.114.000988] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bhuvnesh Aggarwal
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Chad E. Raymond
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Mandeep S. Randhawa
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Eric Roselli
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Jessen Jacob
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Matthew Eagleton
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Damon M. Kralovic
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Kristopher Kormos
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - David Holloway
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Venu Menon
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
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Kapadia SR, Svensson LG, Roselli E, Schoenhagen P, Popovic Z, Alfirevic A, Barzilai B, Krishnaswamy A, Stewart W, Mehta A, Lal Poddar K, Parashar A, Modi D, Ozkan A, Khot U, Lytle BW, Murat Tuzcu E. Single center TAVR experience with a focus on the prevention and management of catastrophic complications. Catheter Cardiovasc Interv 2014; 84:834-42. [PMID: 24407775 PMCID: PMC4231228 DOI: 10.1002/ccd.25356] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/13/2013] [Accepted: 01/03/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single-center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. METHODS The patient population consists of all consecutive patients who underwent an attempted TF-TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium-2. RESULTS During the study period, 255 patients with AS had attempted TF-TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One-year follow-up was complete in 171 (76%) patients. One-year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. CONCLUSIONS TAVR can be accomplished with excellent safety in a tertiary center with a well-developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited.
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Affiliation(s)
- Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Aggarwal B, Raymond CE, Roselli E, Jacob J, Holloway DD, Kormos K, Kralovic D, Menon V. Transfer metrics for patients with suspected acute aortic syndrome. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p359] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chakravarti R, Gupta K, Svensson L, Roselli E, Pettersson G, Johnston D, Soltesz E, Daly T, Stuehr D, Hoffman G. 14-3-3 in large vessel vasculitis: A novel antigen. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.161] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Roselli E, Isabella M, Rajeswaran J, Johnson D, Johnson D, Barzilai B, Blackstone E. WHAT HAPPENS WHEN 3–4+ MITRAL REGURGITATION IS UNTREATED DURING SURGICAL AORTIC VALVE REPLACEMENT? IMPLICATIONS FOR TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61960-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Raymond C, Jacob J, Aggarwal B, Kralovic D, Holloway D, Roselli E, Menon V. IS THERE A BENCHMARK FOR DOOR-OR TIME IN ACUTE TYPE A DISSECTION? J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61519-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria J, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reece TB, Reiss GR, Roselli E, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic valve and ascending aorta guidelines for management and quality measures: executive summary. Ann Thorac Surg 2013; 95:1491-505. [PMID: 23291103 DOI: 10.1016/j.athoracsur.2012.12.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [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: 12/24/2012] [Revised: 12/24/2012] [Accepted: 12/28/2012] [Indexed: 12/24/2022]
Abstract
The Society of Thoracic Surgeons Clinical Practice Guidelines are intended to assist physicians and other health care providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines should not be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the same results. Moreover, these guidelines are subject to change over time, without notice. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of the individual circumstances presented by the patient.
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Affiliation(s)
- Lars G Svensson
- The Cleveland Clinic, 9500 Euclid Ave, Desk F-25 CT Surgery, Cleveland, OH 44195, USA.
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Chaudhary SB, Roselli E, Steinmetz M, Mroz TE. Thoracic aortic dissection and mycotic pseudoaneurysm in the setting of an unstable upper thoracic type b2 fracture. Global Spine J 2012; 2:175-82. [PMID: 24353965 PMCID: PMC3864503 DOI: 10.1055/s-0032-1315452] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 03/26/2012] [Indexed: 12/01/2022] Open
Abstract
Thoracic type B2 fractures are high-energy injuries. It is crucial to maintain a high index of suspicion for concomitant visceral injuries. A 33-year-old man presented after a motor vehicle accident with a T4 type B2.3 fracture with an associated sternum fracture. He was treated with a T4 corpectomy and an expandable titanium cage and lateral plate construct at T3-T5. Two months later he developed focal kyphosis and loosening of his screws. This was addressed with an instrumented posterior fusion from T1 to T8 complicated by a wound infection, pneumonia, and fungal esophagitis requiring several debridements and vacuum assisted closure therapy. Worsening back pain prompted a thoracic computed tomography scan, revealing a dissecting thoracic-aortic aneurysm, which was treated with an endovascular stent graft. Few months later, he presented with fevers, chills, and hemoptysis secondary to Staphylococcus aureus bacteremia, endovascular leak, and T3-T5 osteomyelitis. He was transferred to our institution and restented by the cardiothoracic service. Subsequently, he underwent a thoracotomy, evacuation of infected aneurysmal hematoma with removal of instrumentation. A revision corpectomy with iliac crest autograft reconstruction was performed without complications. The patient's infection and thoracic pain resolved. However, there was a significant delay in treatment, resulting in substantial morbidity. Patients with thoracic type B2 fractures require careful evaluation for concomitant aortic and visceral injuries. Missed associated injuries result in increased morbidity and mortality.
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Affiliation(s)
- Saad B. Chaudhary
- Department of Orthopaedics, New Jersey Medical School–UMDNJ, Newark, New Jersey,Address for correspondence and reprint requests Saad B. Chaudhary, M.D. Department of Orthopaedics, New Jersey Medical School–UMDNJ140 Bergen Street, ACC–D-1610, NewarkNJ 07103
| | - Eric Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael Steinmetz
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thomas E. Mroz
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
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Kitagawa A, Greenberg RK, Eagleton MJ, Mastracci TM, Roselli E. PS2. Fenestrated/Branched Endovascular Aortic Repair (FEVAR) for Chronic Type B Aortic Dissection with Thoracoabdominal Aneurysms (TAAA). J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.094] [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: 11/28/2022]
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35
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Boffa DJ, Gangadharan S, Kent M, Kerendi F, Onaitis M, Verrier E, Roselli E. Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies. Interact Cardiovasc Thorac Surg 2012; 14:797-800. [PMID: 22381653 DOI: 10.1093/icvts/ivr098] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Minimally invasive surgical techniques offer several advantages over traditional open procedures, yet the pathway to minimally invasive proficiency can be difficult to navigate. As a part of an effort of the Joint Council of Thoracic Surgical Education to increase access to this skill set in the general thoracic community, recent graduates of thoracic residencies were surveyed to determine the self-reported achievement of video-assisted thoracic surgery (VATS) lobectomy proficiency and the merits of various educational opportunities. The objective of this study was to estimate the comfort level of recent graduates with the minimally invasive approach, as this demographic not only reflects the current status of training, but represents the future of the specialty. Surgeons graduating North American thoracic residencies between 2006 and 2008 identifying themselves as practitioners of general thoracic surgery were surveyed. A total of 271 surgeons completed training between 2006 and 2008 and indicated general thoracic to be a part of their practice (84 dedicated thoracic and 187 mixed). One hundred and forty-six surgeons completed the survey (54%) including 74 of 84 (88%) dedicated thoracic surgeons. Overall, 58% of recent graduates who perform general thoracic procedures consider themselves proficient in VATS lobectomies (86% of dedicated thoracic surgeons and 28% of surgeons with a mixed practice, P < 0.0001). Of surgeons considering themselves to be proficient at VATS lobectomies, 66% felt thoracic residency was critical or very important to achieving proficiency. Fellowships after completing board residency, animal labs, and follow-up VATS courses put on by experts were much less consistently beneficial. The vast majority of the 25 dedicated general thoracic surgeons who graduate each year consider themselves proficient in VATS lobectomies, largely due to training in their thoracic residencies. On the other hand, the minority of surgeons performing general thoracic procedures as a part of a mixed practice consider themselves proficient in VATS lobectomies. Further study is warranted to enhance the VATS lobectomy experience of mixed practice surgeons particularly during their thoracic residencies.
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Affiliation(s)
- Daniel J Boffa
- Department of Thoracic Surgery, Yale University School of Medicine, Smilow Cancer Hospital, New Haven, CT, USA.
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36
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Kapadia SR, Goel SS, Svensson L, Roselli E, Savage RM, Wallace L, Sola S, Schoenhagen P, Shishehbor MH, Christofferson R, Halley C, Rodriguez LL, Stewart W, Kalahasti V, Tuzcu EM. Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement. J Thorac Cardiovasc Surg 2009; 137:1430-5. [PMID: 19464460 DOI: 10.1016/j.jtcvs.2008.12.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [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] [Received: 09/10/2008] [Revised: 11/22/2008] [Accepted: 12/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Many high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient population remains ill-defined, many of these patients are now being referred for percutaneous aortic valve replacement. We sought to define the characteristics and outcomes of patients referred for percutaneous aortic valve replacement. METHODS Between February 2006 and March 2007, 92 patients were screened for percutaneous aortic valve replacement. Clinical and echocardiographic characteristics of patients undergoing surgical aortic valve replacement, percutaneous aortic valve replacement, balloon aortic valvuloplasty, or no intervention were compared. The primary end point was all-cause mortality. RESULTS Nineteen patients underwent successful surgical aortic valve replacement, 18 patients underwent percutaneous aortic valve replacement, and 36 patients had no intervention. Thirty patients underwent balloon aortic valvuloplasty, and of these, 8 patients were bridged to percutaneous aortic valve replacement and 3 were bridged to surgical aortic valve replacement. Of the remaining 19 patients undergoing balloon aortic valvuloplasty, bridging to percutaneous aortic valve replacement could not be accomplished because of death (n = 9 [47%)], exclusion from the percutaneous aortic valve replacement protocol (n = 6 [32%]), and some patients improved after balloon aortic valvuloplasty and declined percutaneous aortic valve replacement (n = 4 [21%]). The most common reasons for no intervention included death while awaiting definitive treatment (n = 10 [28%]), patient uninterested in percutaneous aortic valve replacement (n = 10 [28%]), and questionable severity of symptoms or aortic stenosis (n = 9 [25%]). Patients not undergoing aortic valve replacement had higher mortality compared with those undergoing aortic valve replacement (44% vs 14%) over a mean duration of 220 days. CONCLUSION Symptomatic patients with severe aortic stenosis have high mortality if timely aortic valve replacement is not feasible. Twenty percent of the patients referred for percutaneous aortic valve replacement underwent surgical aortic valve replacement with good outcome. Patients undergoing balloon aortic valvuloplasty alone or no intervention had unfavorable outcomes.
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Affiliation(s)
- Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Rossetti O, Soldano S, Aseni P, Colombo V, Roselli E, De Gasperi A, Sansalone CV. Renal Grafts From Elderly Donors: Histological Studies and Long-Term Results. Transplant Proc 2007; 39:1820-2. [PMID: 17692621 DOI: 10.1016/j.transproceed.2007.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To satisfy the increasing requests for renal grafts, elderly donors are increasingly accepted for kidney transplant at many centers. The main unresolved question is the long-term effect on graft survival of potential histological lesions due to donor age. We present a prospective histological study performed from January 1997 to December 2001 on 184 consecutively transplanted renal grafts in which the only criterion for graft acceptance was a normal value of serum creatinine upon admission to the intensive care unit independent of donor age. At the end of the study, 57 recipients (31%) of mean age 55 years (range 39 to 67 years) received a renal graft from donors aged more than 60 years (mean age 66 years; range 60 to 75 years), this cohort denoted as older donor kidney transplant group (ODKTG) and 127 recipients (69%) with a mean age of 49 years (range 21 to 63 years) received a renal graft from donors whose age was lower than 60 years (mean age 49 years; range 16 to 59 years), a cohort denoted as the younger donor kidney transplant group (YDKTG). The two groups were comparable for time of dialysis, cold ischemia time, immunosuppression therapy, grading of histological damage. At the end of the study with a mean follow-up of 5.6 years (range 3.5 to 7.5 years), primary graft nonfunction and delayed graft function were significantly more represented in the ODKTG than the YDKTG. Cumulative patient and graft survival was 84.3% and 79.4% in the ODKTG, respectively, and 93.8% and 85.9% in the YDKTG, respectively (P = NS). Cumulative serum creatinine values were 1.98 mg/100 mL in ODKTG and 1.65 mg/100 mL in YDKTG (P = NS). In conclusion, renal grafts from older donors presented histological damage comparable to that seen among renal grafts from younger donors.
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Affiliation(s)
- O Rossetti
- Renal Trasplant Surgery, AO Ospedale Niguarda Ca Granda, Milan, Italy
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Gring CN, Houghtaling P, Novaro GM, Roselli E, Smedira N, Banbury M, Blackstone E, Griffin BP. Preoperative cholesterol levels do not predict explant for structural valve deterioration in patients undergoing bioprosthetic aortic valve replacement. J Heart Valve Dis 2006; 15:261-8. [PMID: 16607910] [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: 05/08/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Structural valve deterioration (SVD) is the most common cause of bioprosthetic valve failure. Coronary disease risk factors, including hypercholesterolemia, might predict SVD. Here, the relationship was examined between preoperative cholesterol levels and SVD in patients undergoing bioprosthetic aortic valve replacement (AVR). METHODS A total of 7,150 patients (mean age 68 +/- 12 years) was identified who underwent bioprosthetic AVR at the Cleveland Clinic Foundation, between January 1975 and December 2002. Preoperative and postoperative variables were retrieved from a prospective, computerized database. A parametric method was used to estimate the distribution of valve explants; a multivariable risk factor model was then developed to include patient demographics, cardiac and non-cardiac comorbidities, valve type and interactions. The primary end-point was explant for SVD. All explants were examined, and observations were censored at the time of any explant or death. Bootstrap analysis was used to validate the model. RESULTS Among 7,150 patients, 208 had explants for SVD. Mean preoperative total cholesterol (TC) was 203 +/- 48 mg/dl, HDL-cholesterol 45 +/- 15 mg/dl, and LDL-cholesterol 121 +/- 41 mg/dl. The average follow up was 3.7 years, and 1,169 patients (16%) were followed for more than eight years. In multivariable analysis, only younger age (p < 0.0001), greater body weight (p < 0.0001), elevated serum creatinine level (p = 0.0004) and use of a pericardial valve (p = 0.04) predicted SVD. Neither preoperative cholesterol nor its fractions predicted valve explant for SVD (log-rank p = 0.19) Moreover, no cardiovascular risk factors were predictive of SVD. CONCLUSION Preoperative cholesterol levels do not predict SVD in patients undergoing bioprosthetic AVR. Whether long-term hypercholesterolemia or statin therapy impacts SVD requires further investigation.
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Affiliation(s)
- Christian N Gring
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Greenberg R, Roselli E. Commentary on "Surgical repair of extensive aortic aneurysms". Perspect Vasc Surg Endovasc Ther 2005; 17:223-6. [PMID: 16273161] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Gonzalez-Stawinski GV, Cook DJ, Chang ASY, Atik F, Navia JL, Banbury M, Roselli E, Young JB, Starling RA, Smedira NG. Early and midterm risk of coronary allograft vasculopathy in patients bridged to orthotopic heart transplantation with ventricular assist devices. Transplantation 2005; 79:1175-9. [PMID: 15880065 DOI: 10.1097/00007890-200505150-00041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary transplant vasculopathy (CAV) has been associated with both immunologic and nonimmunologic factors. The impact of preoperative ventricular assist device (VAD) support on the development of CAV has not been studied. To examine this, we obtained posttransplant coronary angiograms from a group of patients bridged with VAD and compared them to post transplant coronary angiograms of a non-VAD cohort. METHODS Adult patients undergoing orthotopic heart transplant between 1996-2000 were retrospectively studied and divided into VAD and non-VAD patients. Coronary angiograms were retrospectively reviewed and severity of coronary vasculopathy was categorized as trivial, mild, moderate, or severe. Other variables studied included recipient and donor demographics, cytotoxic panel reactive antibodies (PRA) against T-cell targets and flow cytometric crossmatching against donor T lymphocytes. RESULTS There was no significant difference between groups regarding demographics. However, VAD patients had a sixfold greater chance of having a T-cell PRA >10% at the time of transplant (p < 0.05), and a fourfold greater chance of having a positive cross match when compared to non-VAD patients (p < 0.05). There was no significant difference in the degree of CAV between groups. Normal coronary anatomy was present in 76% of VAD patients and 64% of non-VAD patients (p = 0.37). These results were similar at 2- and 3-year follow-up (76 vs. 74% and 80 vs. 62%, respectively). CONCLUSION Preoperative VAD use is associated with increased sensitization; however, these patients develop CAV at the same rate as those not bridged with a VAD.
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Mazza E, De Gasperi A, Corti A, Amici O, Roselli E, Notaro P, Prosperi M, Fantini G, Santandrea E. Hypotension after pancreatic reperfusion during combined kidney-pancreas transplantation. Transplant Proc 1998; 30:265-6. [PMID: 9532027 DOI: 10.1016/s0041-1345(97)01256-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- E Mazza
- Second Servizio di Anestesia, Ospedale Niguarda-Piazza Ospedale Maggiore, Milano, Italy
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Corti A, Degasperi A, Colussi S, Mazza E, Amici O, Cristalli A, Prosperi M, Scaiola A, Vai S, Notaro P, Ceresa F, Roselli E, Settembre A, Santandrea E. [Evaluation of renal function during orthotopic liver transplantation]. Minerva Anestesiol 1997; 63:221-8. [PMID: 9489307] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Orthotopic liver transplantation (OLI) is a recognised means of therapy for endstage liver failure (ESLF). Both the preoperative alterations of renal function, closely correlated with the ESLF, and the frequent and abrupt changes of circulating blood volumes occurring during the various phases of OLT are able to significantly alter renal function during the perioperative period. METHODS In order to define the specific changes of renal function during the various phases of OLT, six postnecrotic cirrhotic patients undergoing their first OLT entered a prospective study protocol. All the patients had standard and anesthetic techniques including the venovenous bypass (VVBP) during the anhepatic phase. At standard intervals (baseline, during hepatic dissection, during the anhepatic phase, following reperfusion, at the end of surgery) together with complete hemodynamic and metabolic profiles, arterial blood and urine samples were obtained to determine electrolytes and creatinine concentrations, blood levels of atrial natriuretic factor, aldosterone and renin activity. Using standard formulas creatinine clearance (Ccreat) and Na absolute and fractional excretions (FeNa%) were calculated. RESULTS Major changes in the hemodynamic profile occurred during the anhepatic phase in spite of the use of the VVBP (reduced cardiac index, reduced pulmonary wedge pressure, increased systemic vascular resistances). Concomitantly a significant decrease in Ccreat (-67%) and in urinary output, was present while aldosterone and renin activity increased. The changes in Ccreat persisted at the end of surgery in spite of the optimal hemodynamic profile. Aldosterone and renin activity returned to values close to baseline at the end of surgery. CONCLUSIONS From these data it is possible to conclude that renal function markedly deteriorates during OLT and it has to be considered at increased risk in the immediate postoperative period. The use of VVBP does not seem to prevent the intraoperative renal impairment.
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Affiliation(s)
- A Corti
- II Servizio Anestesia e Rianimazione, Ospedale Niguarda Ca' Granda, Milano
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De Gasperi A, Mazza E, Corti A, Zoppi F, Prosperi M, Fantini G, Scaiola A, Colella G, Amici O, Notaro P, Rocchini A, Ceresa F, Roselli E, Grugni MC. Lactate blood levels in the perioperative period of orthotopic liver transplantation. Int J Clin Lab Res 1997; 27:123-8. [PMID: 9266283 DOI: 10.1007/bf02912446] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To investigate whether early postoperative changes in blood lactate concentration indicate the functional recovery of the newly grafted liver, changes in oxygen supply, oxygen consumption, acid-base equilibrium, and blood lactate concentrations were prospectively studied in a group of 53 postnecrotic cirrhotic patients during the various phases of orthotopic liver transplantation (preanhepatic, anhepatic, neohepatic) and for the first 48 h following reperfusion. The patients were divided into two groups according to the quality of the early graft function, as indicated by alanine aminotransferase, bile flow, and prothrombin activity: group A (49 patients), good immediate graft function and group B (4 patients), immediate graft non-function. Lactate levels rose in the same manner during the preanhepatic and anhepatic stages and peaked after revascularization of the graft. Following reperfusion, however, distinctly different blood lactate profiles were recorded in the two groups of patients. A fall in lactate concentration was recorded in group A patients, whereas a continuous rise occurred in group B patients: the difference becoming significant by the end of surgery (P < or = 0.05). During the first 48 h following revascularization of the graft, opposite trends in lactate concentration, bile flow, alanine aminotransferase, and prothrombin activity were evident in the two groups of patients: 24 h after reperfusion, lactate levels were below 2 mmol/l in 47 of 49 patients from group A, while they plateaued above 4 mmol/l in all patients from group B. Group A patients had lower alanine aminotransferase levels (P < or = 0.001), higher prothrombin activity, (P < or = 0.01), and greater bile flow (P < or = 0.02). If validated in larger series, the blood lactate profile, probably more than the absolute level, appears to be a useful indicator of the early recovery of liver metabolic capacities in the immediate postoperative period of orthotopic liver transplantation.
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Affiliation(s)
- A De Gasperi
- 2o Servizio di Anestesia, Centro Trapianti di Fegato, Ospedale Niguarda Ca' Granda, Milan, Italy
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De Gasperi A, Nò L, Prosperi M, Notaro P, Amici O, Settembre A, Roselli E, Santandrea E. A.284 Pharmacokinetic profile of the induction dose of propofol In the burned patients. Br J Anaesth 1996. [DOI: 10.1016/s0007-0912(18)31139-5] [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: 11/30/2022] Open
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