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Almassi GH, Quin JA, Stock EM, DeMatt EJ, Biswas K, Hattler B, Tseng E, Zenati MA. Impact of Oral Anticoagulation on Clinical Outcomes in Postoperative Atrial Fibrillation. J Surg Res 2024; 295:122-130. [PMID: 38007859 DOI: 10.1016/j.jss.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/14/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION The impact of postoperative oral anticoagulation (OAC) with warfarin on postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) was the focus of this examination of patients from the randomized endo-vein graft prospective (REGROUP) Trial. MATERIAL AND METHODS REGROUP was a prospective randomized Veterans Affairs cooperative study comparing endoscopic versus open vein harvest in elective CABG patients (March 2014-April 2017) at 16 Veterans Affairs facilities. This study compared new-onset POAF patients who were treated with warfarin versus no-warfarin. Outcomes included stroke during active follow-up and a major adverse cardiac event composite of mortality, acute myocardial infarction, and repeat revascularization during active and passive follow-up. RESULTS Of the 316/1103 (28.6%) of REGROUP patients who developed new-onset POAF, 45 patients were excluded - mainly for preoperative warfarin use. Of the remaining 269 patients, 85 received OAC with warfarin (OAC group); 184 did not (no-OAC group). Stroke rates during active follow-up (32 [IQR 24-38] mo) were 3.5% OAC group versus 5.4% no-OAC group (P = 0.76); major adverse cardiac eventrates were 20% OAC versus 11.4% no-OAC (P = 0.06). On longer follow-up of (median 4.61 [IQR 3.9-5.1] y), discharge OAC use was associated with all-cause mortality after adjusting for Society of Thoracic Surgeons mortality risk (20.0% versus 11.4% no-OAC use; HR = 2.00, 95% CI: 1.05-3.81, P = 0.035). CONCLUSIONS REGROUP patients with POAF treated with OAC had similar stroke and higher mortality rates versus no-OAC patients. Further investigation of the risk-benefit ratio of OAC in post-CABG patients and which POAF patient subgroups might derive the most benefit with anticoagulation appears warranted.
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Affiliation(s)
- G Hossein Almassi
- Division of Cardiothoracic Surgery, Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jacquelyn A Quin
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eileen M Stock
- Cooperative Studies Program, Perry Point/Baltimore Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Ellen J DeMatt
- Cooperative Studies Program, Perry Point/Baltimore Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Kousick Biswas
- Cooperative Studies Program, Perry Point/Baltimore Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Brack Hattler
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | - Elaine Tseng
- Cardiothoracic Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Surgery, University of California in San Francisco, San Francisco, California
| | - Marco A Zenati
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Seadler BD, Melamed J, Sow M, Rogers AL, Syed A, Linsky PL, Ubert HA, Schena S, Durham LA, Almassi GH. A model for delivery of extracorporeal life support in a stand-alone veterans affairs medical center. Artif Organs 2024. [PMID: 38321771 DOI: 10.1111/aor.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION For the Veterans Health Administration (VHA) to continue to perform complex cardiothoracic surgery, there must be an established pathway for providing urgent/emergent extracorporeal life support (ECLS). Partnership with a nearby tertiary care center with such expertise may be the most resource-efficient way to provide ECLS services to patients in post-cardiotomy cardiogenic shock or respiratory failure. The goal of this project was to assess the efficiency, safety, and outcomes of surgical patients who required transfer for perioperative ECLS from a single stand-alone Veterans Affairs Medical Center (VAMC) to a separate ECLS center. METHODS Cohort consisted of all cardiothoracic surgery patients who experienced cardiogenic shock or refractory respiratory failure at the local VAMC requiring urgent or emergent institution of ECLS between 2019 and 2022. The primary outcomes are the safety and timeliness of transport. RESULTS Mean time from the initial shock call to arrival at the ECLS center was 2.8 h. There were no complications during transfer. Six patients (86%) survived to decannulation. CONCLUSION These results suggest that complex cardiothoracic surgery can be performed within the VHA system and when there is an indication for ECLS, those services can be safely and effectively provided at an affiliated, properly equipped center.
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Affiliation(s)
- Benjamin D Seadler
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Joshua Melamed
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Mami Sow
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Austin L Rogers
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Ali Syed
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul L Linsky
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - H Adam Ubert
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stefano Schena
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Lucian A Durham
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Barta LE, Holland HK, Costa HA, Rzepka JW, Almassi GH, Schena S, Pagel PS. Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation? J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00320-8. [PMID: 37225549 DOI: 10.1053/j.jvca.2023.05.012] [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] [Received: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Lauren E Barta
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Hannah K Holland
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Costa
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jason W Rzepka
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Stefano Schena
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Whitaker AR, Tatakis AW, Patel ZH, Sutter HA, Hang D, Almassi GH, Pagel PS. A Highly Unusual Cause of Right Anterior Proximal Clavicle Pain 5 Years After Uncomplicated Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth 2023; 37:187-189. [PMID: 36229291 DOI: 10.1053/j.jvca.2022.09.080] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Allison R Whitaker
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Anna W Tatakis
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zubin H Patel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Dustin Hang
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Bishawi M, Hattler B, Almassi GH, Quin JA, Grover FL, Collins JF, Ebrahimi R, Wolbrom DH, Shroyer AL. Health-related quality of life impacts upon 5-year survival after coronary artery bypass surgery. J Card Surg 2022; 37:4899-4905. [PMID: 36423254 DOI: 10.1111/jocs.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality. METHODS This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05). RESULTS Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p < .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality. CONCLUSIONS Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.
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Affiliation(s)
- Muath Bishawi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacquelyn A Quin
- Department of Surgery, Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Frederick L Grover
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, USA
| | - Ramin Ebrahimi
- Department of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Wolbrom
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
| | - A Laurie Shroyer
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
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Hang D, Iqbal Z, Gebrehiwot Y, Schena S, Joyce LD, Almassi GH, Pagel PS. Multilobular Structure Near the Left Ventricular Apex: Pericardial Effusion or a More Sinister Pathology? J Cardiothorac Vasc Anesth 2022; 36:3982-3985. [PMID: 35786349 DOI: 10.1053/j.jvca.2022.06.002] [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] [Received: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Dustin Hang
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
| | - Zafar Iqbal
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Yizez Gebrehiwot
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Stefano Schena
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lyle D Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - G Hossein Almassi
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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7
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Quin JA, Wagner TH, Hattler B, Carr BM, Collins J, Almassi GH, Grover FL, Shroyer AL. Ten-Year Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Grafting in the Department of Veterans Affairs: A Randomized Clinical Trial. JAMA Surg 2022; 157:303-310. [PMID: 35171210 PMCID: PMC8851363 DOI: 10.1001/jamasurg.2021.7578] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE The long-term benefits of off-pump ("beating heart") vs on-pump coronary artery bypass grafting (CABG) remain controversial. OBJECTIVE To evaluate the 10-year outcomes and costs of off-pump vs on-pump CABG in the Department of Veterans Affairs (VA) Randomized On/Off Bypass (ROOBY) trial. DESIGN, SETTING, AND PARTICIPANTS From February 27, 2002, to May 7, 2007, 2203 veterans in the ROOBY trial were randomly assigned to off-pump or on-pump CABG procedures at 18 participating VA medical centers. Per protocol, the veterans were observed for 10 years; the 10-year, post-CABG clinical outcomes and costs were assessed via centralized abstraction of electronic medical records combined with merges to VA and non-VA databases. With the use of an intention-to-treat approach, analyses were performed from May 7, 2017, to December 9, 2021. INTERVENTIONS On-pump and off-pump CABG procedures. MAIN OUTCOMES AND MEASURES The 10-year coprimary end points included all-cause death and a composite end point identifying patients who had died or had undergone subsequent revascularization (ie, percutaneous coronary intervention [PCI] or repeated CABG); these 2 end points were measured dichotomously and as time-to-event variables (ie, time to death and time to composite end points). Secondary 10-year end points included PCIs, repeated CABG procedures, changes in cardiac symptoms, and 2018-adjusted VA estimated costs. Changes from baseline to 10 years in post-CABG, clinically relevant cardiac symptoms were evaluated for New York Heart Association functional class, Canadian Cardiovascular Society angina class, and atrial fibrillation. Outcome differences were adjudicated by an end points committee. Given that pre-CABG risks were balanced, the protocol-driven primary and secondary hypotheses directly compared 10-year treatment-related effects. RESULTS A total of 1104 patients (1097 men [99.4%]; mean [SD] age, 63.0 [8.5] years) were enrolled in the off-pump group, and 1099 patients (1092 men [99.5%]; mean [SD] age, 62.5 [8.5] years) were enrolled in the on-pump group. The 10-year death rates were 34.2% (n = 378) for the off-pump group and 31.1% (n = 342) for the on-pump group (relative risk, 1.05; 95% CI, 0.99-1.11; P = .12). The median time to composite end point for the off-pump group (4.6 years; IQR, 1.4-7.5 years) was approximately 4.3 months shorter than that for the on-pump group (5.0 years; IQR, 1.8-7.9 years; P = .03). No significant 10-year treatment-related differences were documented for any other primary or secondary end points. After the removal of conversions, sensitivity analyses reconfirmed these findings. CONCLUSIONS AND RELEVANCE No off-pump CABG advantages were found for 10-year death or revascularization end points; the time to composite end point was lower in the off-pump group than in the on-pump group. For veterans, in the absence of on-pump contraindications, a case cannot be made for supplanting the traditional on-pump CABG technique with an off-pump approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01924442.
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Affiliation(s)
- Jacquelyn A. Quin
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
| | - Todd H. Wagner
- Research Office, Veterans Affairs Health Economics and Research Center, Palo Alto, California,Department of Surgery, Stanford University, Palo Alto, California
| | - Brack Hattler
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado,Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Brendan M. Carr
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph Collins
- Research Office, Veterans Affairs Cooperative Studies Program, Perry Point, Maryland
| | - G. Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin,Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Frederick L. Grover
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora,Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - A. Laurie Shroyer
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York,Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
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Topoluk N, Kieffer H, Sutter H, Fayn E, Pagel PS, Almassi GH. Left hemothorax resulting from delayed right ventricular apical pacing lead perforation without hemopericardium, a case report. Int J Surg Case Rep 2022; 93:106924. [PMID: 35286979 PMCID: PMC8924622 DOI: 10.1016/j.ijscr.2022.106924] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Right ventricular pacemaker lead perforation is a rare but well documented complication of pacemaker implantation. Lead perforation can cause an array of symptoms ranging from none to hemodynamic instability and tamponade. In previously reported cases, lead perforation has always been able to be confirmed by imaging, with computed tomography (CT) scan considered to be the gold standard diagnostic imaging modality. CASE PRESENTATION An 80-year-old male underwent uncomplicated implantation of a dual chamber pacemaker for sick sinus syndrome as an outpatient. Thirty-nine days later, the patient presented to the emergency department complaining of new-onset, left-sided, pleuritic chest pain. He was found to have unilateral hemothorax and abnormal pacemaker lead interrogation. Pacemaker lead perforation was suspected but not confirmed with imaging. Lead perforation was only identified after surgical exploration. CLINICAL DISCUSSION This patient had multiple risk factors for pacemaker lead perforation. However, imaging, including CT scan was unable to confirm perforation. The presence of an otherwise unexplained left hemothorax strongly suggested that surgical intervention was indicated. The lead perforation was subsequently confirmed with subxiphoid exploration of the pericardial space. The mechanism of lead perforation resulting in hemothorax in this case is not straight forward, as no direct communication between the pericardial and pleural spaces was identified. However, previously described visceral pericardial self-sealing may contribute to the small pericardial accumulation described herein. CONCLUSION This patient's presentation and clinical course underscore the importance of maintaining a high index of suspicion for pacemaker lead perforation despite a lack of confirmation with imaging.
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Affiliation(s)
- Natasha Topoluk
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Hannah Kieffer
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Heather Sutter
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Evgueni Fayn
- Division of Cardiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
| | - Paul S Pagel
- The Anesthesia (PSP) Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
| | - G Hossein Almassi
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Section of Cardiothoracic Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America.
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Turner H, Beinhoff P, Sonnen AJ, Hang D, Lincoln AH, Sutter HA, Almassi GH, Pagel PS. Progressive Dyspnea and Exercise Intolerance Four Months After Left Ventricular Outflow Tract Radiofrequency Ablation for Frequent Premature Ventricular Contractions. J Cardiothorac Vasc Anesth 2021; 36:2789-2792. [PMID: 34758926 DOI: 10.1053/j.jvca.2021.10.016] [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] [Received: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Halen Turner
- Department of Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Paul Beinhoff
- Department of Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Aly J Sonnen
- Department of Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Dustin Hang
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Anne H Lincoln
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, the Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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10
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Biesboer EA, Ayala GD, Cummings AC, Sutter HA, Iqbal Z, Pagel PS, Almassi GH. Isolated Enterococcus faecalis pulmonary valve endocarditis without precipitating risk factors: A case report describing delayed need for surgery three years after antimicrobial therapy. Int J Surg Case Rep 2021; 87:106426. [PMID: 34601317 PMCID: PMC8496171 DOI: 10.1016/j.ijscr.2021.106426] [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] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Isolated Enterococcus faecalis pulmonary valve endocarditis (PVE) without precipitating risk factors is exceeding rare, as fewer than ten cases have been published in the literature, most of which did not require surgical intervention. CASE PRESENTATION An elderly individual presented for evaluation of dyspnea, fatigue, dizziness, weight loss, and a low-grade fever. The patient denied intravenous drug abuse, blood-borne viral infection, cardiac trauma, congenital heart disease, and immunocompromise. Echocardiography identified a large vegetation on the right pulmonary valve leaflet consistent with isolated PVE. Blood cultures grew E. faecalis. Computed tomography failed to reveal an infectious source. The patient completed a six-week course of antibiotics and was followed with serial echocardiography for three years, but subsequently developed severe pulmonic insufficiency and right heart failure necessitating pulmonary valve replacement. CLINICAL DISCUSSION Isolated PVE is responsible for less than 2.0% of all cases of infective endocarditis. The vast majority of reported cases are associated with risk factors and are caused by gram-positive organisms including Staphylococcus species and Streptococcus viridans. Echocardiography identifies most cases of isolated PVE. Septic embolization of vegetation fragments to lung parenchyma is common. Surgery is reserved for patients who are unresponsive to antibiotics or those who develop severe pulmonary insufficiency with symptoms of right heart failure, as seen here. CONCLUSION We present an unusual case of isolated E. faecalis PVE without known risk factors that required pulmonary valve replacement three years after antimicrobial therapy.
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Affiliation(s)
- Elise A Biesboer
- Department of Surgery, Division of Cardiothoracic Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Gelique D Ayala
- Department of Surgery, Division of Cardiothoracic Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Austin C Cummings
- Department of Surgery, Division of Cardiothoracic Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Heather A Sutter
- Department of Surgery, Division of Cardiothoracic Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Zafar Iqbal
- Anesthesia Service, The Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
| | - Paul S Pagel
- Anesthesia Service, The Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America.
| | - G Hossein Almassi
- Department of Surgery, Division of Cardiothoracic Surgery, The Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiothoracic Surgery Service, The Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States of America
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Pagel PS, Greiber KJ, Sutter HA, Almassi GH. An Unusual Cause of Profound Tricuspid Annular Dilatation Resulting in Severe Regurgitation. J Cardiothorac Vasc Anesth 2021; 36:622-626. [PMID: 34193349 DOI: 10.1053/j.jvca.2021.05.052] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Department of Anesthesiology Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Kyle J Greiber
- Department of Anesthesiology Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Sutter
- Department of Cardiothoracic Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Department of Cardiothoracic Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Wagner BD, Grunwald GK, Hossein Almassi G, Li X, Grover FL, Shroyer ALW. Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting. J Int Med Res 2021; 48:300060520920428. [PMID: 32723120 PMCID: PMC7391442 DOI: 10.1177/0300060520920428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2022] Open
Abstract
Objective Occurrence of a stroke within 30 days following coronary artery bypass grafting (CABG) is an uncommon, but often devastating, complication. This study aimed to identify factors associated with long-term survival (beyond 30 days) in patients with stroke after CABG. Methods De-identified patients’ records from the Veterans Affairs Surgical Quality Improvement Program database were used to identify risk factors and perioperative complications associated with survival for up to 20 years in patients with post-CABG stroke. The multivariable Cox proportional hazards model was used for analyzing survival. Results The median survival time for patients with stroke (n = 1422) was 6.7 years. The mortality rate for these patients was highest in the first year post-CABG and was significantly elevated compared with non-stroke patients. Survival rates at 1, 5, and 10 years for stroke versus non-stroke patients were 79% vs. 96%, 58% vs. 83%, and 36% vs. 63%, respectively. High preoperative serum creatinine levels, postoperative occurrence of renal failure, prolonged ventilation, coma, and reoperation for bleeding were important predictors of 1-year mortality of patients with post-CABG stroke. Conclusions Veterans with post-CABG stroke have a considerably higher risk for mortality during the first year compared with patients without stroke.
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Affiliation(s)
- Brandie D Wagner
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gary K Grunwald
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - G Hossein Almassi
- Zablocki Veterans Affairs Medical Center and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xinli Li
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA
| | - Frederick L Grover
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Laurie W Shroyer
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Research and Development Office, Northport Department of Veterans Affairs Medical Center, Northport, New York, USA
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Plachinski SJ, Salman SS, Carey J, Flanagan CM, Novalija J, Pagel PS, Almassi GH. Iatrogenic Aortic Insufficiency After Radiofrequency Ablation of the Left Ventricular Outflow Tract. J Cardiothorac Vasc Anesth 2021; 36:1726-1729. [PMID: 34103217 DOI: 10.1053/j.jvca.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Sarah J Plachinski
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Sumaiya S Salman
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - James Carey
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jutta Novalija
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI; Department of Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Department of Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - G Hossein Almassi
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI; Department of Cardiothoracic Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Wyler von Ballmoos MC, Almassi GH. Commentary: Postoperative atrial fibrillation: An old foe in a new light. J Thorac Cardiovasc Surg 2021; 164:1845-1846. [PMID: 33965227 DOI: 10.1016/j.jtcvs.2021.04.021] [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: 04/07/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston, Tex; Weill Cornell Medicine, New York, NY
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis; Zablocki Veterans Affairs Medical Center, Milwaukee, Wis.
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Wyler von Ballmoos MC, Almassi GH. Commentary: A stitch in time saves nine, but medical therapy makes that stitch shine. J Thorac Cardiovasc Surg 2021; 164:1900-1901. [PMID: 33558112 DOI: 10.1016/j.jtcvs.2020.12.139] [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: 12/30/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston, Tex; Department of Cardiothoracic Surgery, DeBakey Heart and Vascular Center, Weill Cornell Medicine, New York, NY
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
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Quin JA, Noubani M, Rove JY, Krstacic JE, Hattler B, Collins JF, Grover FL, Almassi GH, Shroyer AL. Coronary Artery Bypass Grafting Transit Time Flow Measurement: Graft Patency and Clinical Outcomes. Ann Thorac Surg 2020; 112:701-707. [PMID: 33359134 DOI: 10.1016/j.athoracsur.2020.12.011] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND This subanalysis of the Randomized On-Off Bypass (ROOBY) trial examined transit time flow measurement (TTFM) use and its impact on graft patency and long-term clinical outcomes after coronary artery bypass graft surgery. METHODS Use of TTFM for ROOBY centers and surgeons was assessed. Comparative patient outcomes based on TTFM use included 1-year graft patency and 1-year and 5-year major adverse cardiac events: all-cause mortality, nonfatal myocardial infarction, and revascularization (percutaneous coronary intervention or repeat coronary artery bypass graft surgery). RESULTS Transit time flow measurement was used in 1067 patients (TTFM group) and not used in 501 patients (non-TTFM group); of the TTFM group, median percentage TTFM use was 79% (interquartile range, 41% to 98%) among 18 Veterans Affairs Medical Centers, and 74% (interquartile range, 13% to 98%) among 48 surgeons. Patients were comparable in age (63 ± 8.5 years TTFM vs 62 ± 8 years non-TTFM, P = .30) and estimated 30-day mortality risk (1.8 ± 1.7 TTFM vs 1.9 non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988 grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM assessed grafts (P < .01). Fewer TTFM patients had an occluded graft (29%, vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients, 5-year major adverse cardiac event rates were 30% vs 25% (P = .06). Individual component rates were 14% vs 11% for death (P = .06), 12% vs 8.8% for myocardial infarction (P = .07), and 13% vs 12% for revascularization (P = .62). CONCLUSIONS The association of TTFM use with graft patency and clinical outcome is uncertain. Future randomized studies that account for patient risk factors and practice variation would help address this knowledge gap.
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Affiliation(s)
- Jacquelyn A Quin
- VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Mohammad Noubani
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
| | - Jessica Y Rove
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John E Krstacic
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
| | - Brack Hattler
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Frederick L Grover
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - G Hossein Almassi
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Laurie Shroyer
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
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Davidovich RM, Mathews BM, Iqbal Z, Jean XV, Sutter HA, Almassi GH, Pagel PS. A Figure of Eight and a Circle Within a Circle: Is This Left Ventricular Geometry Responsible for Multiple Embolic Strokes Two Years After Inferior Wall Myocardial Infarction? J Cardiothorac Vasc Anesth 2020; 35:1892-1896. [PMID: 33191043 DOI: 10.1053/j.jvca.2020.10.038] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan M Davidovich
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Benjamin M Mathews
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zafar Iqbal
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Xavier V Jean
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Pagel PS, Wasson ET, Davidovich RM, Singh D, Almassi GH. Severe Tricuspid Regurgitation in an Elderly Man With a Pacemaker Generator Eroding Through the Skin: Endocarditis, Perforation, Lead-Induced Impingement, or Another Mechanism? J Cardiothorac Vasc Anesth 2020; 35:1544-1548. [PMID: 33158708 DOI: 10.1053/j.jvca.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesiology, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Ethan T Wasson
- Anesthesiology, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Ryan M Davidovich
- Anesthesiology, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Dalip Singh
- Cardiology, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Wyler von Ballmoos MC, Almassi GH. Commentary: The relationship of cancer and heart disease-it's complicated. J Thorac Cardiovasc Surg 2020; 164:115-116. [PMID: 34756324 DOI: 10.1016/j.jtcvs.2020.09.104] [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: 09/22/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston, Tex; Weill Cornell Medicine, New York, NY
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis; Zablocki Veterans Affairs Medical Center, Milwaukee, Wis.
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Wyler von Ballmoos MC, Almassi GH. Commentary: The original pandemic-stemming the tide of overweight, diabetes, hypertension, and dyslipidemia after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2020; 163:2104-2105. [PMID: 32948301 DOI: 10.1016/j.jtcvs.2020.08.048] [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: 08/16/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston, Tex; Weill Cornell Medicine, New York, NY
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis; Zablocki Veterans Affairs Medical Center, Milwaukee, Wis.
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21
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Wyler von Ballmoos MC, Almassi GH. Commentary: Delayed gratification and optimism bias: Navigating quality and quantity of life with revascularization in patients with ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2020; 161:1032-1033. [PMID: 32800361 DOI: 10.1016/j.jtcvs.2020.07.049] [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: 07/13/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston, Tex; Weill Cornell Medicine, New York, NY
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis; Zablocki VA Medical Center, Milwaukee, Wis.
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Lazicki TJ, Krishnan R, Fredrickson KA, Sutter HA, Almassi GH, Pagel PS. Severe Eccentric Aortic Regurgitation: An Unusual Manifestation of Disease Progression Resulting From Leaflet Prolapse, Perforation, Destruction, or Vegetation? J Cardiothorac Vasc Anesth 2020; 35:951-953. [PMID: 32651037 DOI: 10.1053/j.jvca.2020.06.050] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Timothy J Lazicki
- Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Radhika Krishnan
- Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Kyla A Fredrickson
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Almassi GH, Hawkins RB, Bishawi M, Shroyer AL, Hattler B, Quin JA, Collins JF, Bakaeen FG, Ebrahimi R, Grover FL, Wagner TH. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg 2019; 161:1803-1810.e3. [PMID: 31866082 DOI: 10.1016/j.jtcvs.2019.10.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/14/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. METHODS Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. RESULTS Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. CONCLUSIONS No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years.
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Affiliation(s)
- G Hossein Almassi
- Cardiothoracic Surgery, Zablocki Veterans Affairs Medical Center, Milwaukee, Wis; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
| | - Robert B Hawkins
- Department of Surgery, Salem Veterans Affairs Medical Center, Salem, Va; Department of Surgery, University of Virginia, Charlottesville, Va
| | - Muath Bishawi
- Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Department of Surgery, Duke University Medical Center, Durham, NC
| | - A Laurie Shroyer
- Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Brack Hattler
- Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo
| | - Jacquelyn A Quin
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass; Harvard Medical School, Boston, Mass
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, Md
| | - Faisal G Bakaeen
- Department of Surgery, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pa; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ramin Ebrahimi
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif; Department of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Frederick L Grover
- Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Medical Center, Menlo Park, Calif; Department of Surgery, Stanford University, Stanford, Calif
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Hill GE, Thorsen TN, Goelz AP, Miller RE, Almassi GH, Pagel PS. A Rare Consequence of Remote Blunt Chest Trauma. J Cardiothorac Vasc Anesth 2019; 33:2875-2881. [DOI: 10.1053/j.jvca.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 11/11/2022]
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Pagel PS, Millen HT, Peterson TS, Gandhi SD, Lohr NL, Almassi GH. An Apparent Large Pericardial Effusion: A Consequence of Dual Antiplatelet Therapy or an Entirely Different Diagnosis? J Cardiothorac Vasc Anesth 2019; 34:1105-1110. [PMID: 31558397 DOI: 10.1053/j.jvca.2019.08.053] [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] [Received: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Hana T Millen
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Trevor S Peterson
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Sweeta D Gandhi
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Nicole L Lohr
- Cardiology Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Chinn A, Knabel M, Sanger JR, Pagel PS, Almassi GH. Chronic Serratia marcescens sternal infection presenting 13 years after coronary artery surgery. Int J Surg Case Rep 2019; 62:50-53. [PMID: 31445500 PMCID: PMC6717065 DOI: 10.1016/j.ijscr.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/15/2019] [Revised: 08/02/2019] [Accepted: 08/10/2019] [Indexed: 11/03/2022] Open
Abstract
Serratia marcescens is gram-negative facultative anaerobic bacillus. S. marcescens is responsible for a small percentage of hospital-acquired infections. S. marcescens infection usually occurs in outbreaks. This case describes a rare chronic S. marcescens sternal infection.
Introduction Serratia marcescens is a facultative anaerobic bacillus that very rarely causes sternal infections. We describe a sternal abscess resulting from chronic S. marcescens infection that presented 13 years after coronary artery bypass graft surgery (CABG). Presentation of case A 71-year-old diabetic man presented 13 years after CABG with a new distal sternal “mass” that intermittently drained purulent fluid. He was treated with oral antibiotics, but the symptoms persisted. Exploration revealed an abscess extending to the sternal body. A non-absorbable braided suture and a sternal wire were removed, but a sinus tract remained despite further antibiotics and conservative care. Subsequent computed tomography and bone scintigraphy revealed a substernal soft tissue density with bone involvement. An abscess cavity was excised from the substernal anterior mediastinum. Another non-absorbable braided suture was removed. Cultures grew carbapenem-resistant S. marcescens. Discussion Nosocomial or hospital-associated clusters of S. marcescens infection are known, but isolated infections seldom occur. S. marcescens infections in cardiac surgery patients are unusual. Only a single report described a chronic sternal infection resulting from S. marcescens that was identified 15 years after an initial episode caused by the same organism in a heart transplant recipient who was immunocompromised. Diabetes and non-absorbable braided sutures placed for hemostasis at the wire sites were probably contributing factors to our patient’s chronic infection. Conclusion This report described the presentation and treatment of a chronic S. marcescens sternal abscess that occurred 13 years after CABG. Chronic sternal infections due to this organism in cardiac surgery patients are exceeding rare.
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Affiliation(s)
- Ashley Chinn
- Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - Michael Knabel
- Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
| | - James R Sanger
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States; Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Paul S Pagel
- Department of Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States.
| | - G Hossein Almassi
- Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States
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Wyler von Ballmoos MC, Almassi GH. Commentary: Hybrid graft to the rescue of the bilateral internal thoracic artery debate-Is it time for new technology or new techniques? J Thorac Cardiovasc Surg 2019; 159:474-475. [PMID: 31029449 DOI: 10.1016/j.jtcvs.2019.03.082] [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: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Tex; Weill Cornell Medicine, New York, NY
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
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Hattler B, Carr BM, Messenger J, Spertus J, Ebrahimi R, Bishawi M, Quin JA, Almassi GH, Collins JF, Kozora E, Grover FL, Shroyer ALW. Clinical and Angiographic Predictors of Patient-Reported Angina 1 Year After Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Qual Outcomes 2019; 12:e005119. [DOI: 10.1161/circoutcomes.118.005119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brack Hattler
- Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.)
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - Brendan M. Carr
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
| | - John Messenger
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - John Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri at Kansas City, Kansas City, MO (J.S.)
| | - Ramin Ebrahimi
- Greater Los Angeles VA Medical Center, Los Angeles, CA (R.E.)
- University of California, Los Angeles (R.E.)
| | - Muath Bishawi
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
- Duke University, Durham, NC (M.B.)
| | - Jacquelyn A. Quin
- VA Boston Healthcare System, West Roxbury, MA (J.A.Q.)
- Harvard Medical School, Boston, MA (J.A.Q.)
| | - G. Hossein Almassi
- Zablocki Veterans Affairs Medical Center, Milwaukee, WI (G.H.A.)
- Medical College of Wisconsin, Milwaukee (G.H.A.)
| | - Joseph F. Collins
- Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.)
| | - Elizabeth Kozora
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
- National Jewish Health, Denver, CO (E.K.)
| | - Frederick L. Grover
- Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.)
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - A. Laurie W. Shroyer
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
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Zenati MA, Bhatt DL, Bakaeen FG, Stock EM, Biswas K, Gaziano JM, Kelly RF, Tseng EE, Bitondo J, Quin JA, Almassi GH, Haime M, Hattler B, DeMatt E, Scrymgeour A, Huang GD. Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass. N Engl J Med 2019; 380:132-141. [PMID: 30417737 DOI: 10.1056/nejmoa1812390] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarctions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082 .).
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Affiliation(s)
- Marco A Zenati
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Deepak L Bhatt
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Faisal G Bakaeen
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Eileen M Stock
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Kousick Biswas
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - J Michael Gaziano
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Rosemary F Kelly
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Elaine E Tseng
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Jerene Bitondo
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Jacquelyn A Quin
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - G Hossein Almassi
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Miguel Haime
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Brack Hattler
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Ellen DeMatt
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Alexandra Scrymgeour
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
| | - Grant D Huang
- From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.)
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Hill GED, Aranda PS, Harvey JF, Olund TJ, Almassi GH, Joyce LD, Pagel PS. A Rare Cause of Stroke Four Weeks After Ascending Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth 2018; 33:1473-1476. [PMID: 30292389 DOI: 10.1053/j.jvca.2018.09.002] [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] [Received: 08/31/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Graham E D Hill
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Patrick S Aranda
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Julie F Harvey
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Olund
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Lyle D Joyce
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Shroyer ALW, Quin JA, Wagner TH, Carr BM, Collins JF, Almassi GH, Bishawi M, Grover FL, Hattler B. Off-Pump Versus On-Pump Impact: Diabetic Patient 5-Year Coronary Artery Bypass Clinical Outcomes. Ann Thorac Surg 2018; 107:92-98. [PMID: 30273568 DOI: 10.1016/j.athoracsur.2018.07.076] [Citation(s) in RCA: 10] [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: 02/16/2018] [Revised: 06/18/2018] [Accepted: 07/23/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND For diabetic patients who require coronary artery bypass graft (CABG) operation, controversy persists whether an off-pump or an on-pump approach may be advantageous. This US-based, multicenter, randomized, controlled trial, Department of Veterans Affairs Randomization On versus Off Bypass Follow-up Study, compared diabetic patients' 5-year clinical outcomes for off-pump versus on-pump procedures. METHODS From 2002 to 2008, 835 medically treated (ie, oral hypoglycemic agent or insulin) diabetic patients underwent either off-pump (n = 402) or on-pump (n = 433) CABG. Five-year primary end points included all-cause death and major adverse cardiovascular events (MACE; composite included all-cause death, myocardial infarction, or repeat revascularization). Secondary 5-year end points included cardiac death and MACE-related components. With baseline risk factors balanced, outcomes were evaluated by using a p value less than or equal to 0.01; nonsignificant trends were reported for p values greater than 0.01 and less than or equal to 0.15. RESULTS Five-year all-cause death rates were 20.2% off pump versus 14.1% on pump (p = 0.0198). No differences were seen in MACE (32.6% off-pump approach versus 28.6% on-pump approach, p = 0.216), repeat revascularization (12.4% off-pump approach versus 11.8% on-pump approach, p = 0.770), and nonfatal myocardial infarction (12.7% off-pump approach versus 10.4% on-pump approach, p = 0.299). Cardiac death trended worse with off-pump CABG (9.0%) than with on-pump CABG (6.25%, p = 0.137). Sensitivity analyses that removed conversions confirmed these findings. CONCLUSIONS With a 6.1% absolute difference, a strong trend toward improved 5-year survival was observed with on-pump CABG for medically treated diabetic patients. No off-pump advantage was found for any 5-year end points. A future clinical trial now appears warranted to rigorously compare off-pump versus on-pump longer term outcomes for diabetic patients.
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Affiliation(s)
- A Laurie W Shroyer
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York; Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado.
| | - Jacquelyn A Quin
- Department of Surgery, VA Boston Healthcare System, West Roxbury, Massachusetts
| | - Todd H Wagner
- Department of Veterans Affairs Health Economics Resource Center, Palo Alto, California; Department of Surgery, Stanford University, Palo Alto, California
| | - Brendan M Carr
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York; Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, Maryland
| | - G Hossein Almassi
- Department of Surgery, Zablocki VA Medical Center, Milwaukee, Wisconsin; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muath Bishawi
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York; Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frederick L Grover
- Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Brack Hattler
- Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Wagner TH, Hattler B, Bakaeen FG, Collins JF, Almassi GH, Quin JA, Grover FL, Bishawi M, Shroyer ALW. Costs Five Years After Off-Pump or On-Pump Coronary Artery Bypass Surgery. Ann Thorac Surg 2018; 107:99-105. [PMID: 30273569 DOI: 10.1016/j.athoracsur.2018.07.075] [Citation(s) in RCA: 6] [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: 04/17/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a common surgical treatment for ischemic heart disease. Little is known about the long-term costs of conducting the surgery on-pump or off-pump. METHODS As part of the Randomized On/Off Bypass follow-up study, we followed 2,203 participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104) CABG for 5 years using Department of Veterans Affairs and Medicare administrative data. We examined annual costs through 5 years, standardized to 2016 dollars, using multivariate regression models, controlling for site and baseline patient factors. RESULTS In the first year, including the CABG surgery, annual average costs were $66,599 (SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the off-pump group. In years 2 to 5, average costs ranged from $15,000 to $20,000 per year. There was no significant difference between on-pump and off-pump across the 5 years. We explored differences among high-risk subgroups (diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, renal dysfunction, ejection fraction < 35%, over age 70 years), and found no treatment assignment by time interactions, except for a nonsignificant trend in patients with diabetes. CONCLUSIONS At 5 years, the average costs of off-pump and on-pump CABG patients did not statistically differ. Costs do not favor one approach and the decision should be based on clinical risks, especially in subgroups. Future research is warranted to examine post-CABG costs and outcomes for diabetic patients over time.
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Affiliation(s)
- Todd H Wagner
- VA Palo Alto Health Economics Resource Center, Menlo Park, California; Department of Surgery, Stanford University, Palo Alto, California.
| | - Brack Hattler
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | - G Hossein Almassi
- Veterans Affairs Medical Center, Milwaukee, Wisconsin; Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Frederick L Grover
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado
| | - Muath Bishawi
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - A Laurie W Shroyer
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Northport VA Medical Center, Northport, New York
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Pagel PS, Telles-Hernandez L, Miller R, Hill GED, Almassi GH. Selective Partial Obstruction of Inferior Vena Cava Blood Flow During Diastole: Cor Triatriatum Dexter, Large Eustachian Valve, or Chiari Network? J Cardiothorac Vasc Anesth 2018; 33:575-578. [PMID: 30174263 DOI: 10.1053/j.jvca.2018.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 07/23/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Luis Telles-Hernandez
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Rebecca Miller
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Graham E D Hill
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Greaves SW, Dye L, Aranda PS, Cain MT, Haasler GB, Almassi GH, Pagel PS, Kreibich M, Beyersdorf F, Elefteriades JA. Perioperative Management of a Large Idiopathic Pulmonary Artery Aneurysm Without Pulmonary Arterial Hypertension. J Cardiothorac Vasc Anesth 2018; 32:2402-2408. [PMID: 29887125 DOI: 10.1053/j.jvca.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 01/22/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Spencer W Greaves
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Lonnie Dye
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Patrick S Aranda
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Michael T Cain
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - George B Haasler
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
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Encarnacion CO, Almassi GH. Another win for multiarterial bypass grafting: What's next? J Thorac Cardiovasc Surg 2018; 156:52-53. [PMID: 29602422 DOI: 10.1016/j.jtcvs.2018.03.010] [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: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Carlos O Encarnacion
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis.
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Ebrahimi R, Gupta S, Carr BM, Bishawi M, Bakaeen FG, Almassi GH, Collins J, Grover FL, Quin JA, Wagner TH, Shroyer ALW, Hattler B. Comparison of Outcomes and Costs Associated With Aspirin ± Clopidogrel After Coronary Artery Bypass Grafting. Am J Cardiol 2018; 121:709-714. [PMID: 29402422 DOI: 10.1016/j.amjcard.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
Optimal antiplatelet therapy after coronary artery bypass graft (CABG) surgery remains controversial. This study evaluated the role of dual antiplatelet therapy using aspirin and clopidogrel (DAPT) versus antiplatelet therapy using aspirin only (ASA) on post-CABG clinical outcomes and costs. In the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively collected beginning in year 2 of this study to include 1,525 of the 2,203 original ROOBY patients who received aspirin after CABG. Discretionarily, surgeons after CABG administered either DAPT or ASA treatments. The ROOBY trial's primary 30-day composite (mortality or perioperative morbidity), 1-year composite (all-cause death, repeat revascularization, or nonfatal myocardial infarction), and costs were compared for these 2 strategies. Of the 1,525 subjects, 511 received DAPT and 1,014 received ASA. DAPT subjects, compared with ASA subjects, had lower rates of preoperative left ventricular ejection fraction of ≥45% (78.8% vs 85.7%, p <0.001), on-pump CABG (36.6% vs 57.1%, p = 0.001), and endoscopic vein harvesting (30.0% vs 42.8%, p <0.001). ASA patients were more likely to have earlier aspirin administration and receive 325 versus 81 mg dosages. The 30-day composite outcome rate was significantly lower for DAPT patients compared with ASA patients (3.3% vs 7.1%, p = 0.003), but the 1-year composite outcome was equal between the 2 groups (12.0% vs12.0%, p = 1.0). At 1 year, there were no cost differences between the 2 groups. Propensity analyses did not significantly alter the results. In conclusion, DAPT appeared safe and was associated with fewer 30-day adverse outcomes than aspirin only and with no 1-year outcome or cost differences.
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Almassi GH. Dissolution is not the solution. J Thorac Cardiovasc Surg 2018; 155:2020. [PMID: 29395203 DOI: 10.1016/j.jtcvs.2017.12.028] [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: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
Affiliation(s)
- G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis.
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Quin JA, Hattler B, Shroyer ALW, Kemp D, Almassi GH, Bakaeen FG, Carr BM, Bishawi M, Collins JF, Grover FL, Wagner TH. Concordance between administrative data and clinical review for mortality in the randomized on/off bypass follow-up study (ROOBY-FS). J Card Surg 2017; 32:751-756. [PMID: 29239024 DOI: 10.1111/jocs.13379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal methodology to identify cardiac versus non-cardiac cause of death following cardiac surgery has not been determined. METHODS The Randomized On/Off Bypass Trial was a multicenter, randomized, controlled clinical trial of 2203 patients (February 2002-May 2008) comparing 1-year cardiac outcomes between off-pump and on-pump bypass surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program funded a follow-up study to assess 5-year outcomes including mortality. Deaths were identified and confirmed using the National Death Index (NDI), VA Vital Status file, and medical records. An Endpoints Committee (EC) reviewed patient medical records and classified each cause of death as cardiac, non-cardiac, or unknown. Using pre-determined ICD-10 codes, NDI death certificates were independently used to classify deaths as cardiac or non-cardiac. Cause of death was compared between the NDI and EC classifications and concordance measured, using Kappa statistics. RESULTS Of the 297 5-year deaths identified by the NDI and/or VA vital status file and confirmed by the EC, 219 had adequate patient records for EC cause of death determination. The EC adjudicated 141 of these deaths as non-cardiac and 78 as cardiac, while the NDI classified 150 as non-cardiac and 69 as cardiac; agreement was 77.6% (kappa 0.500; P < 0.001). CONCLUSIONS Since concordance between EC and NDI cause of death classifications was only moderate, caution should be exercised in relying exclusively on NDI data to determine cause of death. A hybrid approach, integrating multiple information sources, may provide the most accurate approach to classifying cause of death.
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Affiliation(s)
- Jacquelyn A Quin
- Surgical Service, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Brack Hattler
- Department of Medicine, Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.,School of Medicine at the Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Annie Laurie W Shroyer
- Research and Development Office, Northport Veterans Affair Medical Center, Northport, New York.,Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado
| | - Darlene Kemp
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | - G Hossein Almassi
- Surgical Services, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Faisal G Bakaeen
- Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brendan M Carr
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York.,Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Muath Bishawi
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York.,Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | - Frederick L Grover
- School of Medicine at the Anschutz Medical Campus, University of Colorado, Aurora, Colorado.,Department of Surgery, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Todd H Wagner
- Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, California.,Department of Surgery, Stanford University, Stanford, California
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Almassi GH. Cox Maze IV procedure is effective, but is it for everybody? J Thorac Cardiovasc Surg 2017; 155:171. [PMID: 29102211 DOI: 10.1016/j.jtcvs.2017.09.109] [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: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022]
Affiliation(s)
- G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis.
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Pagel PS, Zdanovec AK, Laden NS, Almassi GH. Progressive Dyspnea in a Man With Recently Treated Presumed Endocarditis: The Usual Onset of Valvular Incompetence or More Complex Pathology? J Cardiothorac Vasc Anesth 2017; 32:1525-1528. [PMID: 28967622 DOI: 10.1053/j.jvca.2017.04.053] [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] [Received: 04/24/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Amber K Zdanovec
- Anesthesia Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Nathaniel S Laden
- Cardiothoracic Surgery Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Freed JK, Simon JA, Iqbal Z, Almassi GH, Pagel PS. An Unusual Cause of an Isolated Transient Ischemic Attack in an Otherwise Healthy Elderly Man. J Cardiothorac Vasc Anesth 2017; 32:1529-1532. [PMID: 28927695 DOI: 10.1053/j.jvca.2017.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Julie K Freed
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jacqueline A Simon
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zafar Iqbal
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA, Almassi GH, Kozora E, Bakaeen F, Cleveland JC, Bishawi M, Grover FL. Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. N Engl J Med 2017; 377:623-632. [PMID: 28813218 DOI: 10.1056/nejmoa1614341] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronary-artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes in patients who had been included in the Veterans Affairs trial of on-pump versus off-pump CABG. METHODS From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The two primary 5-year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less. RESULTS The rate of death at 5 years was 15.2% in the off-pump group versus 11.9% in the on-pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off-pump group versus 27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5-year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off-pump group and 9.6% in the on-pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02). CONCLUSIONS In this randomized trial, off-pump CABG led to lower rates of 5-year survival and event-free survival than on-pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY-FS ClinicalTrials.gov number, NCT01924442 .).
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Affiliation(s)
- A Laurie Shroyer
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Brack Hattler
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Todd H Wagner
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Joseph F Collins
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Janet H Baltz
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Jacquelyn A Quin
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - G Hossein Almassi
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Elizabeth Kozora
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Faisal Bakaeen
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Joseph C Cleveland
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Muath Bishawi
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Frederick L Grover
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
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Pagel PS, Sethi P, Freed JK, Boettcher BT, Hossein Almassi G. A Rare Complication of Cardiopulmonary Resuscitation After Mitral Valve Replacement. J Cardiothorac Vasc Anesth 2016; 31:770-772. [PMID: 27693210 DOI: 10.1053/j.jvca.2016.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 07/09/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Paul S Pagel
- Department of Anesthesia, The Clement J. Zablocki Veterans Affairs Center, Milwaukee, WI.
| | - Pawan Sethi
- Department of Anesthesia, The Clement J. Zablocki Veterans Affairs Center, Milwaukee, WI
| | - Julie K Freed
- Department of Anesthesia, The Clement J. Zablocki Veterans Affairs Center, Milwaukee, WI
| | - Brent T Boettcher
- Department of Anesthesia, The Clement J. Zablocki Veterans Affairs Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, The Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Encarnacion CO, Loranger AM, Bharatkumar AG, Almassi GH. Bacterial Endocarditis Caused by Lactobacillus acidophilus Leading to Rupture of Sinus of Valsalva Aneurysm. Tex Heart Inst J 2016; 43:161-4. [PMID: 27127435 DOI: 10.14503/thij-15-5121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lactobacillus acidophilus rarely causes bacterial endocarditis, because it usually resides in the mucosa of the vagina, gastrointestinal tract, and oropharynx. Moreover, sinus of Valsalva aneurysms are rare cardiac anomalies, either acquired or congenital. We present the case of a middle-aged man whose bacterial endocarditis, caused by Lactobacillus acidophilus, led to an aneurysmal rupture of the sinus of Valsalva into the right ventricular outflow tract. The patient underwent successful surgical repair, despite numerous complications and sequelae.
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Almassi GH, Shroyer ALW, Bakaeen FG. A victory for all Halstedians: Evidence supporting cardiac surgical residents training. J Thorac Cardiovasc Surg 2016; 151:1215-6. [PMID: 26995625 DOI: 10.1016/j.jtcvs.2015.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/24/2022]
Affiliation(s)
- G Hossein Almassi
- Cardiothoracic Surgery, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee, Wis
| | - A Laurie W Shroyer
- Surgery, Northport VA Medical Center and Stony Brook School of Medicine, Stony Brook, NY
| | - Faisal G Bakaeen
- Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Almassi GH, Carr BM, Bishawi M, Shroyer AL, Quin JA, Hattler B, Wagner TH, Collins JF, Ravichandran P, Cleveland JC, Grover FL, Bakaeen FG. Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg 2015; 150:1428-35, 1437.e1; discussion 1435-7. [DOI: 10.1016/j.jtcvs.2015.08.124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/06/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
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MacGillivray TE, Sundt T, Almassi GH, Pomar JL. Discussion. J Thorac Cardiovasc Surg 2015; 151:408-9. [PMID: 26586356 DOI: 10.1016/j.jtcvs.2015.09.114] [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: 10/22/2022]
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48
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Pagel PS, De Vry DJ, Lopez BE, Zdanovec AK, Price BN, Encarnación CO, Kryniak MP, Almassi GH. A Highly Mobile Mass in the Anterior Left Ventricular Outflow Tract Immediately Beneath a Heavily Calcified, Stenotic Aortic Valve: Vegetation, Thrombus, or Neoplasm? J Cardiothorac Vasc Anesth 2015; 29:1740-2. [PMID: 26277438 DOI: 10.1053/j.jvca.2015.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 04/26/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Minerva P Kryniak
- Pathology Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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De Vry DJ, Poblocki JR, Algahim MF, Hossein Almassi G, Pagel PS. Mechanism of Torrential Aortic Valve Insufficiency in Endocarditis: Leaflet Destruction, Restriction, Prolapse, or Perforation? J Cardiothorac Vasc Anesth 2015; 29:1734-6. [PMID: 26275515 DOI: 10.1053/j.jvca.2015.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Derek J De Vry
- Anesthesia, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Joseph R Poblocki
- Anesthesia, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Mohamed F Algahim
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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De Vry DJ, Barker PH, Vardanyan M, Milosavljevic SL, Dygert TN, Jurva JW, Wyler Van Ballmoos MC, Gandhi SD, Hossein Almassi G, Pagel PS. Pneumonia and Inflammatory Arthritis Caused by Unusual Occupational Exposure or a Life-Threatening Infection Resulting From a More Commonly Encountered Mechanism? J Cardiothorac Vasc Anesth 2015; 29:1096-9. [PMID: 25976604 DOI: 10.1053/j.jvca.2015.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 01/06/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Paul H Barker
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | | | | | | | | | | | | | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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