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Kumar A, Shariff M, Singal A, Bhat V, Stulak J, Reed G, Kalra A. A Bayesian meta-analysis of double kissing (DK) crush or provisional stenting for coronary artery bifurcation lesions. Indian Heart J 2024:S0019-4832(24)00049-X. [PMID: 38537883 DOI: 10.1016/j.ihj.2024.03.004] [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: 09/11/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE Despite the development of dedicated, two-stent strategies, including the double kissing (DK) crush technique, the ideal technique for coronary artery bifurcation stenting has not been identified. We aimed to compare and determine the absolute risk difference (ARD) of the DK crush technique alone versus provisional stenting approaches for coronary bifurcation lesions, using the Bayesian technique. METHOD We queried PubMed/MEDLINE to identify randomized controlled trials (RCTs) that compared DK crush technique with provisional stenting for bifurcation lesions, published till January 2023. We used Bayesian methods to calculate the ARD and 95% credible interval (CrI). RESULTS We included three RCTs, with 916 patients, in the final analysis. The ARD of cardiac death was centered at -0.01 (95% CrI: -0.04 to 0.02; Tau: 0.02, 85% probability of ARD of DK crush vs. provisional stenting <0). ARD for myocardial infarction was centered at -0.03 (95%CrI: -0.9 to 0.03; Tau: 0.05, 87% probability of ARD of DK crush vs. provisional stenting <0). ARD for stent thrombosis was centered at 0.00 (95% CrI: -0.04 to 0.03, Tau: 0.03, 51% probability of ARD for DK crush vs. provisional stenting <0). Finally, ARD for target lesion revascularization was centered at -0.05 (95% CrI: -0.08 to -0.03, Tau: 0.02, 99.97% probability of ARD for DK crush vs. provisional stenting <0). CONCLUSIONS Bayesian analysis demonstrated a lower probability of cardiac death, myocardial infarction and target lesion revascularization, with DK crush compared with provisional stenting techniques, and a minimal probability of difference in stent thrombosis.
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aayush Singal
- Department of Cardiology, Aakash Healthcare, New Delhi, India
| | - Vivek Bhat
- Department of Medicine, St. John's Medical College, Bangalore, India
| | - John Stulak
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Franciscan Health, Lafayette, IN, USA; Krannert Cardiovascular Research Center, Indianapolis, IN, USA.
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2
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Ghandour H, Weiss AJ, Gaudino M, Halkos M, Chu D, Taylor BS, Puskas J, Bhatt DL, Zenati M, Stulak J, Rosengart T, Balkhy HH, Blackstone EH, Svensson LG, Bakaeen FG, Erten O, Karamlou T, Soltesz EG, Gillinov AM, Warmuth A, Roselli EE, Smedira NG. Public reporting for coronary artery bypass graft surgery: The quest for the optimal scorecard. J Thorac Cardiovasc Surg 2023; 166:805-815.e1. [PMID: 35525802 DOI: 10.1016/j.jtcvs.2022.01.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A number of publicly available rating algorithms are used to assess hospital performance in coronary artery bypass grafting (CABG). However, concerns remain that these algorithms fail to correlate with each other and inadequately capture the case complexity of individual center practices. METHODS Composite star ratings for isolated CABG from the Society of Thoracic Surgeons public reporting database were extracted for 2018-2019. U.S. News & World Report Best Hospitals was used to extract CABG ratings as well as overall cardiology and heart surgery ranking, and the Centers for Medicare & Medicaid Services Hospital Compare was used to extract CABG volume and 30-day mortality. Spearman correlation coefficients were used to assess possible relationships. Expert opinion on risk adjustment and program evaluation was incorporated. RESULTS Correlations between Society of Thoracic Surgeons star rating and U.S. News & World Report overall ranking in cardiology and heart surgery (r = 0.15) and Centers for Medicare & Medicaid Services 30-day mortality (r = -0.27) were poor. Society of Thoracic Surgeons star rating correlated weakly with U.S. News & World Report CABG ratings (r = 0.33) and with Centers for Medicare & Medicaid Services CABG volume (r = 0.32), whereas the latter 2 correlated moderately (r = 0.52) with each other. Of the 75 centers with accredited cardiac surgery training programs, 13 (17%) did not participate in Society of Thoracic Surgeons public reporting. Important gaps were identified in risk assessment, and potential solutions are proposed. CONCLUSIONS Correlations between current CABG public reporting systems are weak. Further work is needed to refine and standardize CABG rating systems to more adequately capture the scope and complexity of an individual center's clinical practice and to better inform patients.
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Affiliation(s)
- Hiba Ghandour
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aaron J Weiss
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, NY
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | | | - John Puskas
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
| | - Marco Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Mass
| | - John Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Todd Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Eugene H Blackstone
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ozgun Erten
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tara Karamlou
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Eric E Roselli
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas G Smedira
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Mendoza MA, Ranganath N, Garcia BB, Stevens RW, Lahr B, O’Horo J, Stulak J, Shah A. Left Ventricular Assist Device: Review of Antimicrobial Prophylaxis Strategies and Incidence of Infections at a Tertiary Care Center 12-Year Experience. Open Forum Infect Dis 2023; 10:ofad465. [PMID: 37732167 PMCID: PMC10508979 DOI: 10.1093/ofid/ofad465] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
Background Left ventricular assist devices (LVAD) have an associated infection rate of 13%-80% postimplant. An optimal strategy for surgical infection prophylaxis (SIP) at the time of implantation has not been well defined. We aimed to evaluate the different LVAD implantation antibiotic prophylaxis regimens as well as the incidence of LVAD infection at our institution. Methods We performed a single-center, retrospective study of patients who underwent LVAD implantation between February 2007 and June 2019. The primary outcome was the incidence of LVAD infection (LVADI), within 3 months and 1 year of placement, between patients who received expanded or narrow-spectrum regimens for SIP. We assessed outcomes using Kaplan-Meier, time-to-first event. We used a noninferiority analysis, which was established if the narrow-spectrum event rate was no more than 5% greater than the expanded-spectrum event rate. Results We included 399 patients, 305 (76.4%) patients received narrow-spectrum SIP, whereas the remaining 94 (23.6%) patients received the expanded-spectrum regimen. Statistical noninferiority of the narrow spectrum to the multiple drug regimen was demonstrated at both time points, and statistical superiority of the narrow-spectrum group across 12-month follow up was further evident (P = .037). Conclusions We report evidence supporting noninferiority, or even superiority, of the narrow-spectrum over expanded-spectrum antimicrobial prophylaxis strategy with respect to LVADI. These findings support data-driven antimicrobial prophylaxis strategies.
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Affiliation(s)
- Maria Alejandra Mendoza
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Nischal Ranganath
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Bismarck Bisono Garcia
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan W Stevens
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Lahr
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - John O’Horo
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya Shah
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
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Chambergo-Michilot D, De la Cruz-Ku G, Sterner RM, Brañez-Condorena A, Guerra-Canchari P, Stulak J. Clinical characteristics, management, and outcomes of patients with primary cardiac angiosarcoma: A systematic review. J Cardiovasc Thorac Res 2023; 15:1-8. [PMID: 37342661 PMCID: PMC10278191 DOI: 10.34172/jcvtr.2023.30531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/10/2023] [Indexed: 06/23/2023] Open
Abstract
Primary cardiac angiosarcomas (PCA) are highly aggressive malignant heart tumors. Previous reports have shown a poor prognosis regardless of management, and no consensus or guidelines exist. It is necessary to clarify this information since patients with PCA have a short survival. Therefore, we aimed to systematically review clinical manifestations, management, and outcomes. We systematically searched in PubMed, Scopus, Web of Science, and EMBASE. We intended to include cross-sectional studies, case-control studies, cohort studies, and case series that reported clinical characteristics, management, and outcomes of patients with PCA. As a methodological approach, we used the Joanna Briggs Institute Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale for cohorts. We included six studies (five case series, one cohort). The mean/median age ranged from 39 to 48.9 years. Male sex was predominant. The most frequent manifestations were dyspnea (range: 50%-80%), pericardial effusion (29% & 56%), and chest pain (10%-39%). The mean tumor size ranged from 5.8 to 7.2 cm, with the majority of these localized in the right atrium (70-100%). The most common locations of metastasis were the lung (20%-55.6%), liver (10%-22.2%), and bone (10%-20%). Resection (22.9%-94%), and chemotherapy as neoadjuvant or adjuvant (30%-100%) were the most commonly used methods of treatment. Mortality ranged from 64.7% to 100%. PCA often presents late in its course and usually results in poor prognosis. We strongly recommend performing multi-institutional prospective cohorts to better study disease course and treatments to develop consensus, algorithms, and guidelines for this type of sarcoma.
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Affiliation(s)
- Diego Chambergo-Michilot
- Universidad Científica del Sur, Lima, Perú
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Perú
| | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Perú
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Surgery of the University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Ana Brañez-Condorena
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Perú
- Asociación de Investigación Estudiantil en Ciencias de la Salud, Lima, Perú
| | - Pedro Guerra-Canchari
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Perú
- Sociedad Científica de San Fernando, Lima, Perú
| | - John Stulak
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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5
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Tan N, Quam B, Friedman PA, Lerman A, Stulak J, Attia ZI, Melduni R, Lee HC. RISK FACTORS FOR POSTOPERATIVE ATRIAL FIBRILLATION FOLLOWING CORONARY ARTERY BYPASS SURGERY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Schettle S, Shahin Y, Dunlay S, Daly R, Glasgow A, Habermann E, Stulak J, Rosenbaum A. Opioid usage after left ventricular assist device implantation: A single center retrospective analysis. Heart Lung 2023; 59:82-87. [PMID: 36773441 DOI: 10.1016/j.hrtlng.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Opioid use disorder is a known national concern and extends across multiple populations; however, opioid use in the left ventricular assist device (LVAD) population and subsequent outcomes is not well described. OBJECTIVES We sought to understand opioid use and patient characteristics among the LVAD population at a single center and associated outcomes after index LVAD hospitalization in relation to opioid use. METHODS A single center retrospective review of pre-operative and post-operative opioid use was characterized during the index admission for LVAD implantation. Additionally, we reviewed medical records from patients with opioid prescription at hospital discharge stratified by oral morphine equivalents (OME) and refills of opioid prescriptions with analysis of the outcomes of readmission and death after hospital discharge from the index admission for LVAD implantation. RESULTS Opioid exposed patients in this cohort increased in frequency from 0% of patients in 2007 to a peak of 25.9% of patients in 2013, and gradually declined thereafter to 12.5% in 2017. CONCLUSIONS Despite the rate of high dose opioid therapy in this cohort, neither opioid use, opioid history, oral morphine equivalents (OME), or opioid refills portended worse survival after LVAD implantation.
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Affiliation(s)
- Sarah Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Youssef Shahin
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shannon Dunlay
- Department of Advanced Heart Failure Cardiology and Cardiac Transplant, Mayo Clinic, Rochester, MN, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy Glasgow
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Habermann
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA; Department of Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew Rosenbaum
- Department of Advanced Heart Failure Cardiology and Cardiac Transplant, Mayo Clinic, Rochester, MN, USA
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7
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Crestanello JA, Greason K, Elsisy M, Lahr B, Bagameri G, Daly R, Stulak J, Dearani J, Schaff H. Impact of time to chest closure on early and late survival in adults with delayed sternal closure. Eur J Cardiothorac Surg 2023; 63:7030692. [PMID: 36749008 DOI: 10.1093/ejcts/ezad044] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Delayed sternal closure (DSC) after cardiac surgery is a temporizing measure to address coagulopathy or haemodynamic instability after cardiac surgery. We sought to study: (i) indications and temporal trends for DSC, (ii) factors associated with time to chest closure and (iii) its impact on short-term and long-term outcomes. METHODS From January 2007 to December 2017, 494 patients (median age 67 years, 66% males) required DSC after cardiac surgery. Medical records were reviewed for indications, risk factors, time to DSC and outcomes. Multivariable Cox regression via landmark analysis of 486 5-day survivors was used to investigate the impact of time to chest closure on early and late survival. RESULTS Coagulopathy and haemodynamic instability were the most common indications. Median time to chest closure was 2 days. Pre-/intraoperative extracorporeal membranous oxygenation, severe right ventricular dysfunction and diabetes mellitus were associated with longer time to chest closure. Longer time to closure was associated with increased risk of operative complications and operative mortality, but did not have a statistically significant association with late mortality. Increasing age, pulmonary hypertension and a greater number of prior sternotomies were also found to be associated with overall mortality. CONCLUSIONS While longer time to chest closure was associated with increased rates of operative complications and operative mortality, it did not reveal a statistically significant association with long-term survival.
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Affiliation(s)
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamed Elsisy
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Mendoza MA, Ranganath N, O’Horo JC, Stulak J, Shah A. 1801. LVAD antimicrobial prophylaxis and infections, a 12-year experience. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
The incidence of end-stage heart failure necessitating advanced cardiac therapy continues to increase in the United states. Implantable left ventricular assist devices (LVADs) represent an important modality that is utilized both as a bridge to heart transplant or as destination therapy. LVAD-associated infections, ranging from driveline exit site or pocket infections to endovascular infections, are a major complication with high mortality. Antibiotic prophylaxis at time of LVAD implantation is therefore an important strategy to mitigate infections. However, a clear surgical infection prophylaxis regimen and associated outcomes have not been reported.
Methods
We performed a single center, retrospective cohort study evaluating the impact of antimicrobial prophylaxis on risk of infection in patients who underwent LVAD implantation between February 2007 and June 2019 at Mayo Clinic. LVAD-specific and related infections were defined according to the International Society of Heart Lung Transplantation criteria. Single drug prophylaxis (SDP) included cefazolin only, vancomycin only, or cefazolin and vancomycin; multidrug (MDP) regimen includes either of the SDP regimens plus another antibiotic. We compared incidence of infection within 90-day and within one-year of implantation, as well as risk of C. difficile infections between the SDP and MDP cohorts.
Results
We reviewed 403 patients who received LVAD implantation (Table 1), 402 of had information on surgical prophylaxis. 307 (76%) patients received SDP and 95 patients (24%) received MDP. 14 patients developed an infection within 1 year of implantation (Table 2). There was no difference in the incidence of infections between SDP and MDP arms both at 90 days and 1-year post-implantation (p=0.11). The median time of infection since LVAD implantation was similar between SDP and MDP (p=0.37) arms. Incidence of C. difficile infection was not different between groups (p=0.10) (Table 3).
Conclusion
There was no significant difference in incidence or time to first infection, within 90-day and 1-year of implantation, between single- and multidrug antibiotic surgical prophylaxis regimens administered at the time of LVAD implantation. Future prospective trials are needed to develop a clear LVAD antibiotic prophylaxis protocol.
Disclosures
John C. O'Horo, Sr., MD, MPH, Bates college: Advisor/Consultant|MITRE corporation: Grant/Research Support|nferenec, Inc: Grant/Research Support.
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Lund S, D'Angelo JD, Baloul M, Yeh VJH, Stulak J, Rivera M. Simulation as Soothsayer: Simulated Surgical Skills MMIs During Residency Interviews are Associated With First Year Residency Performance. J Surg Educ 2022; 79:e235-e241. [PMID: 35725725 DOI: 10.1016/j.jsurg.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)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/18/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The main consideration during residency recruitment is identifying applicants who will succeed during residency. However, few studies have identified applicant characteristics that are associated with competency development during residency, such as the Accreditation Council for Graduate Medical Education milestones. As mini multiple interviews (MMIs) can be used to assess various competencies, we aimed to determine if simulated surgical skills MMI scores during a general surgery residency interview were associated with Accreditation Council for Graduate Medical Education milestone ratings at the conclusion of intern year. DESIGN Retrospective cohort study. Interns' Step 1 and 2 clinical knowledge (CK) scores, interview day simulated surgical skills MMI overall score, traditional faculty interview scores, average overall milestone ratings in the spring of residency, and intern American Board of Surgery In-Training Examination (ABSITE) percentile scores were gathered. Two multiple linear regression were performed analyzing the association between Step 1, Step 2 CK, MMI, and traditional faculty interview scores with (1) average overall milestone rating and (2) ABSITE percentile scores, controlling for categorical/preliminary intern classification. SETTING One academic medical center PARTICIPANTS: General surgery interns matriculating in 2020-2021 RESULTS: Nineteen interns were included. Multiple linear regression revealed that higher overall simulated surgical skills MMI score was associated with higher average milestone ratings (β = .45, p = 0.03) and higher ABSITE score (β = .43, p = 0.02) while neither Step 1, Step 2 CK, nor faculty interview scores were significantly associated with average milestone ratings. CONCLUSIONS Surgical residency programs invest a tremendous amount of effort into training residents, thus metrics for predicting applicants that will succeed are needed. Higher scores on a simulated surgical skills MMIs are associated with higher milestone ratings 1 year into residency and higher intern ABSITE percentiles. These results indicate a noteworthy method, simulated surgical skills MMIs, as an additional metric that may select residents that will have early success in residency.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, Rochester, Minnesota.
| | | | | | - Vicky J-H Yeh
- Mayo Clinic Department of Surgery, Rochester, Minnesota
| | - John Stulak
- Mayo Clinic Department of Cardiovascular Surgery, Rochester, Minnesota
| | - Mariela Rivera
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, Rochester, Minnesota
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10
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Khullar V, Ahmed E, Greason K, Choi K, Stulak J, King K, Villavicencio M, Daly R, Dearani J, Crestanello J, Schaff H. Impact of Concomitant Coronary Artery Bypass Grafting on Postoperative Outcomes in Patients Undergoing Pericardiectomy: A 33 Year Experience. JTCVS Open 2022; 13:178-183. [PMID: 37063133 PMCID: PMC10091208 DOI: 10.1016/j.xjon.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
Objective Concomitant coronary artery bypass grafting (CABG) and pericardiectomy (PC) can be a technically challenging operation. We sought to study the outcomes of patients undergoing concomitant PC and CABG. Methods Between July 1983 and August 2016, 70 patients (median age, 67 years; 88% males) underwent concomitant PC and CABG (PC + CABG group). Multivariable analysis was used to identify predictors of mortality. Matched patients who underwent isolated PC (PC group) were identified, and postoperative outcomes and long-term survival in the 2 groups were compared. Results Compared with the PC group, cardiopulmonary bypass time was significantly longer in the PC + CABG group (82 minutes vs 61 minutes; P < .001). In-hospital mortality was 4% in the PC group and 7% in the PC + CABG group (P = .380). Multivariable analysis identified peripheral vascular disease (hazard ratio [HR], 2.67; 95% CI, 1.06-6.76; P = .04) as a predictor of increased morbidity or mortality and a borderline association with New York Heart Association functional classes III and IV (HR, 2.41; 95% CI, 0.99-5.86; P = .05) with increased morbidity and mortality in the PC + CABG group. Kaplan-Meier estimates demonstrated similar late mortality rates in the 2 groups at a 15-year follow-up (P = .700). Conclusions Concomitant PC and CABG is not associated with increased morbidity or mortality compared with isolated PC. Thus, CABG should not be denied at the time of PC.
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11
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Goodman D, Stulak J, Rosenbaum AN. Left ventricular assist devices: A historical perspective at the intersection of medicine and engineering. Artif Organs 2022; 46:2343-2360. [PMID: 35929377 DOI: 10.1111/aor.14371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Over the last half-century, left ventricular assist device (LVAD) technology has progressed from conceptual therapy for failed cardiopulmonary bypass weaning to an accepted destination therapy for advanced heart failure. The history of LVAD engineering is defined by an initial development phase, which demonstrated the feasibility of such an approach, to the more recent three major generations of commercial devices. In this review, we explore the engineering challenges of LVADs, how they were addressed over time, and the clinical outcomes that resulted from each major technological development. The first generation of commercial LVADs were pulsatile devices, which lacked the appropriate durability due to their number of moving components and hemocompatibility. The second generation of LVADs was defined by replacement of complex, pulsatile pumps with primarily axial, continuous-flow systems with an impeller in the blood passageway. These devices experienced significant commercial success, but the presence of excessive trauma to the blood and in-situ bearing resulted in an unacceptable burden of adverse events. Third generation centrifugal-flow pumps use magnetically suspended rotors within the pump chamber. Superior outcomes with this newest generation of devices have been observed, particularly with respect to hemocompatibility-related adverse events including pump thrombosis, with fully magnetically levitated devices. The future of LVAD engineering includes wireless charging foregoing percutaneous drivelines and more advanced pump control mechanisms, including synchronization of the pump flow with the native cardiac cycle, and varying pump output based on degree of physical exertion using sensor or advanced device-level data triggers.
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Affiliation(s)
- Daniel Goodman
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa, USA
| | - John Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew N Rosenbaum
- Department of Cardiovascular Diseases, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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Schettle S, Frantz R, Stulak J, Villavicencio M, Rosenbaum A. HeartWare Thrombosis After mRNA COVID-19 Vaccination. Mayo Clin Proc 2022; 97:1399-1401. [PMID: 35787869 PMCID: PMC9110650 DOI: 10.1016/j.mayocp.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
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Schettle S, Villavicencio M, Stulak J, Inglis S, Kushwaha S, Clavell A, Rosenbaum A. Fecal Transplant for Recurrent Clostridium difficile Colitis in CF-LVAD Supported Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163:1231-1249. [PMID: 35090765 DOI: 10.1016/j.jtcvs.2021.11.091] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Md
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Kim CH, Sajgalik P, Cierzan B, Ziegler B, Schettle SD, Clavell A, Stulak J, Johnson BD. Pulmonary Capillary Recruitment Is Attenuated Post Left Ventricular Assist Device Implantation. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Inglis S, Villavicencio M, Schettle S, Stulak J, Clavell A, Kushwaha S, Behfar A, Rosenbaum A. Interventricular Septal Output While Supported on LVAD Therapy. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rosenbaum A, Rossman T, Reddy Y, Villavicencio M, Stulak J, Schettle S, Kushwaha S, Behfar A. Pulsatile Pressure Delivery of Continuous Flow LVAD is Speed Dependent and Markedly Reduced Relative to Heart Failure Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. Ann Thorac Surg 2022; 113:1073-1092. [PMID: 35090687 DOI: 10.1016/j.athoracsur.2021.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Schettle S, Villavicencio M, Stulak J, Inglis S, Kushwaha S, Clavell A, Rosenbaum A. Does Hemoglobin A1c Accurately Depict Diabetic Control in LVAD Patients? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ramaprabhu K, Saran N, Dearani J, Lahr B, Schaff H, Greason K, Yalamuri S, Mangukia C, Stulak J, Bagameri G, Crestanello J, Pochettino A. Cannulation strategies for acute type A dissection—role of central cannulation. Eur J Cardiothorac Surg 2022; 62:6561483. [DOI: 10.1093/ejcts/ezac207] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES
The purpose of this study was to assess the safety and efficacy of direct cannulation of the ascending aorta in comparison with cannulating peripheral arteries.
METHODS
We retrospectively analysed type A dissection patients [n = 107; median (interquartile range [IQR]) age, 64 [53–73] years] from January 2008 to March 2018. The cohort was divided into 2 groups: direct ascending aorta cannulation (group A, n = 47; median [IQR] age, 69 [54–74] years; 34% female) and non-aortic cannulation (group B, n = 60; median [IQR] age, 62 [52–72] years; 20% female). Postoperative outcomes and long-term survival were compared.
RESULTS
Baseline characteristics were not significantly different between the 2 groups, except for higher creatinine in group B (median 0.9 vs 1.1, P = 0.028) and higher prevalence of dyslipidaemia in group A (58.7% vs 38.3%, P = 0.037). Overall early mortality was 12.1% (n = 13); 12.8% (n = 6) in group A and 11.7% (n = 7) in group B (P = 0.863). The incidence of stroke was 10.6% (n = 5) in group A and 6.7% (n = 4) in group B (P = 0.463). After adjusting for CPB and circulatory arrest times, there was no group difference in the length of ICU (P = 0.257) or hospital stay (P = 0.118), all-cause reoperation (P = 0.709), peak postoperative creatinine (P = 0.426) and lactate values (n = 60; P = 0.862). Overall survival at 1, 3 and 5 years was 84%, 78% and 73%, respectively, with no difference between the 2 groups after adjustment (P = 0.629).
CONCLUSIONS
Direct cannulation of the ascending aorta is a safe cannulation strategy for type A dissection repair, offering the opportunity for rapid arterial cannulation and antegrade perfusion.
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Affiliation(s)
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Suraj Yalamuri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chirantan Mangukia
- Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Weber MP, Stulak J, Maltais S, Pagani FD, Cowger J, Tchantchaleishvili V. Quality of Life Metrics in LVAD Patients after Hemocompatibility-Related Adverse Events. Artif Organs 2022; 46:1616-1625. [PMID: 35315092 DOI: 10.1111/aor.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/21/2022] [Accepted: 02/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemocompatibility-related adverse events (HRAE) negatively influence survival. However, no study has examined the impact of these events on health-related quality of life (HRQOL) and functional outcomes following continuous flow left ventricular assist device implantation (CF-LVAD). We assessed the impact of HRAE events on HRQOL and hypothesized that HRAE's adversely impact HRQOL and functional outcomes. METHODS INTERMACS database identified patients undergoing primary CF-LVAD implantation from 2008 to 2017. HRAEs included stroke, non-surgical bleeding, hemolysis, and pump thrombosis and were identified as defined in the literature. HRAEs were further stratified as Tier 1-2 and disabling stroke events. Time-series analysis was executed for HRAE patients with values pre-HRAE, post-HRAE, and closest to 12 month follow up. Local polynomial regression curves modeling individual patients were superimposed into "spaghetti" plots. RESULTS All HRQOL and functional metrics improved in patients over time, despite HRAE complication. However, these patient metrics were significantly reduced compared to the non-HRAE cohort (Table 2). Advanced data visualization techniques noted decline after experiencing an HRAE with a subsequent recovery to baseline levels or higher (Figure1-4). 6MWT was noted to be most affected in the post-HRAE period but recovered similar to other metrics (Table 3). CONCLUSIONS The burden of HRAE following CF-LVAD implantation did not negatively impact quality of life. However, 6-minute walk test did not increase in the post-HRAE period in all HRAE patients. Improvement of heart failure symptoms after CF-LVAD coupled with optimal management following HRAE act to preserve enhanced quality of life.
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Affiliation(s)
- Matthew P Weber
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - John Stulak
- Department of Surgery, Division of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States
| | - Simon Maltais
- Division of Cardiac Surgery, Centre Hospitalié de l'Université de Montréal, Montréal, QC, Canada
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | - Jennifer Cowger
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
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Schettle S, Rosenbaum A, Goodman D, Stulak J. De Ritis-adjusted AST provides comparable efficacy to lactate dehydrogenase as a biomarker for detection of LVAD hemolysis or thrombosis. Artif Organs 2022; 46:1425-1428. [PMID: 35318681 DOI: 10.1111/aor.14236] [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: 10/26/2021] [Revised: 02/05/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lactate hydrogenase (LDH) is a common biomarker utilized in the detection and monitoring of left ventricular assist device (LVAD) hemolysis and thrombosis. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are common laboratory tests that can be used to calculate the De Ritis ratio and the De Ritis adjusted AST. METHODS A retrospective review of LVAD patients was performed to identify three cohorts of patients: those with confirmed pump thrombosis after device exchange, those with LVAD-related hemolysis who were medically managed without pump exchange, and those who did not meet these criteria and served as the control cohort. Evaluation of AST, AST/ALT ratio (referred to as the De Ritis ratio) as well as AST x (AST/ALT) or the De Ritis-adjusted AST (DRA) was performed. RESULTS There were 29 patients who underwent device exchange for thrombosis, 25 patients who were diagnosed with hemolysis and treated medically (clopidogrel (N = 6), heparin (N = 13), tirofiban (N = 8), eptifibatide (N = 2), and some received more than one of these treatments), and 425 control patients. A qualitatively comparable relative and absolute rise in DRA and LDH were found in both surgically managed pump thrombosis and suspected device-related hemolysis. CONCLUSIONS Both AST and LDH as well DRA are significantly associated with pump thrombosis (p < 0.0001 for each). DRA is a potential screening biomarker for hemolysis and device thrombosis in stable left ventricular assist device patients.
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Affiliation(s)
- Sarah Schettle
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Rosenbaum
- Advanced Heart Failure Cardiology and Cardiac Transplant, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Goodman
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Lund S, D'Angelo J, D'Angelo AL, Heller S, Stulak J, Rivera M. New Heuristics to Stratify Applicants: Predictors of General Surgery Residency Applicant Step 1 Scores. J Surg Educ 2022; 79:349-354. [PMID: 34776371 DOI: 10.1016/j.jsurg.2021.10.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In 2022, United States Medical Licensing Examination (USMLE) Step 1 scores will become pass/fail. This may be problematic, as residency programs heavily rely on USMLE Step 1 scores as a metric when determining interview invitations. This study aimed to assess candidate application metrics associated with USMLE Step 1 scores to offer programs new cues for stratifying applicants. DESIGN Retrospective cohort study analyzing interviewed applicants to one general surgery residency program in 2019 and 2020. Applicant data analyzed included USMLE Step 1 scores, number of publications, clerkship scores, letter of recommendation scores (out of 2, scored by 0.25 interval), interview overall score (out of 5, scored by integer level), and standardized question score (out of 10). Each year, applicant's answers to one standardized behavioral question during their interview were scored by interviewers. SETTING Tertiary medical center, academic general surgery residency program. PARTICIPANTS Interviewed applicants at one general surgery residency program whose applications contained complete demographic information (203 out of 247). RESULTS Multiple Linear Regression revealed that higher surgical clerkship (β = 0.19, p = 0.006) and higher standardized interview question (β = 0.32, p < 0.001) scores were positively associated with applicant USMLE Step 1 score (F[7, 195] = 6.61, p < 0.001, R2 = 0.19). Letter of recommendation score, number of peer reviewed publications, gender, race, and applicant type (preliminary/categorical) were not associated with USMLE Step 1 scores. CONCLUSIONS With USMLE Step 1 scores transitioning to pass/fail, surgical residency programs need new selection heuristics. Surgery clerkship scores and standardized behavioral questions answered by applicants prior to the interview could provide a holistic view of applicants and help programs better stratify candidates without USMLE Step 1 scores.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, Rochester, Minnesota.
| | | | | | - Stephanie Heller
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, Rochester, Minnesota
| | - John Stulak
- Mayo Clinic Department of Cardiovascular Surgery, Rochester, Minnesota
| | - Mariela Rivera
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, Rochester, Minnesota
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Lund S, Hinduja P, Doherty J, Rose S, Stulak J, Rivera M. Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution. J Grad Med Educ 2022; 14:64-70. [PMID: 35222823 PMCID: PMC8848869 DOI: 10.4300/jgme-d-21-00295.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/30/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic affected graduate medical education (GME) by decreasing elective procedures and disrupting didactic learning activities in 2020. Editorials have hypothesized that resident physicians worked fewer hours, therefore losing valuable experience, but we are not aware of studies that have objectively assessed changes in hours worked. OBJECTIVE This study aims to identify differences secondary to the COVID-19 pandemic in resident work hours across all specialties at 3 geographically dispersed, integrated academic hospitals in a large sponsoring institution. METHODS We obtained de-identified work hour data from all residency programs at Mayo Clinic in Arizona, Florida, and Minnesota. Resident work hours were compared between 2020 and 2019 from March to May. RESULTS Work hours for 1149 and 1118 residents during the pandemic and control periods respectively were compared. Decreases in resident work hours were seen, with the largest decrease demonstrated in April 2020 when 19 of 43 programs demonstrated significantly decreased work hours. Residents worked more hours from home in April 2020 compared to the previous year (Arizona: mean 1 hour in 2019 vs 5.2 hours in 2020, P<.001; Florida: mean 0.7 hour in 2019 vs 6.5 hours in 2020, P<.001; Minnesota: mean 0.8 hour in 2019 vs 10.2 hours in 2020, P<.001). CONCLUSIONS The COVID-19 pandemic was associated with a decrease in work hours in some, but not all, specialties. The decrease in on-site work was only partially offset by an increased number of hours worked from home.
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Affiliation(s)
- Sarah Lund
- All authors are with the Mayo Clinic, Rochester
- Sarah Lund, MD, is a PGY-4 Resident, Department of Surgery
| | - Pranav Hinduja
- All authors are with the Mayo Clinic, Rochester
- Pranav Hinduja, MBBS, is a PGY-1 Resident, Department of Surgery
| | - Julie Doherty
- All authors are with the Mayo Clinic, Rochester
- Julie Doherty, MBA, is Operations Manager, School of Graduate Medical Education
| | - Steven Rose
- All authors are with the Mayo Clinic, Rochester
- Steven Rose, MD, is Dean and Designated Institutional Official, School of Graduate Medical Education
| | - John Stulak
- All authors are with the Mayo Clinic, Rochester
- John Stulak, MD, is General Surgery Program Director, Department of Cardiovascular Surgery
| | - Mariela Rivera
- All authors are with the Mayo Clinic, Rochester
- Mariela Rivera, MD, is General Surgery Associate Program Director, Division of Trauma, Critical Care, and General Surgery
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Rosenbaum AN, Antaki JF, Behfar A, Villavicencio MA, Stulak J, Kushwaha SS. Physiology of Continuous-Flow Left Ventricular Assist Device Therapy. Compr Physiol 2021; 12:2731-2767. [PMID: 34964115 DOI: 10.1002/cphy.c210016] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The expanding use of continuous-flow left ventricular assist devices (CF-LVADs) for end-stage heart failure warrants familiarity with the physiologic interaction of the device with the native circulation. Contemporary devices utilize predominantly centrifugal flow and, to a lesser extent, axial flow rotors that vary with respect to their intrinsic flow characteristics. Flow can be manipulated with adjustments to preload and afterload as in the native heart, and ascertainment of the predicted effects is provided by differential pressure-flow (H-Q) curves or loops. Valvular heart disease, especially aortic regurgitation, may significantly affect adequacy of mechanical support. In contrast, atrioventricular and ventriculoventricular timing is of less certain significance. Although beneficial effects of device therapy are typically seen due to enhanced distal perfusion, unloading of the left ventricle and atrium, and amelioration of secondary pulmonary hypertension, negative effects of CF-LVAD therapy on right ventricular filling and function, through right-sided loading and septal interaction, can make optimization challenging. Additionally, a lack of pulsatile energy provided by CF-LVAD therapy has physiologic consequences for end-organ function and may be responsible for a series of adverse effects. Rheological effects of intravascular pumps, especially shear stress exposure, result in platelet activation and hemolysis, which may result in both thrombotic and hemorrhagic consequences. Development of novel solutions for untoward device-circulatory interactions will facilitate hemodynamic support while mitigating adverse events. © 2021 American Physiological Society. Compr Physiol 12:1-37, 2021.
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Affiliation(s)
- Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,VanCleve Cardiac Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
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D'Angelo J, Lund S, D'Angelo AL, Heller S, Stulak J, Rivera M. A New Era in Assessment of Applicants to General Surgery Residency-Simulated Skills Tests for 3 Domains. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lund S, Shaikh N, Yeh VJH, Baloul M, de Azevedo R, Peña A, Becknell M, Que F, Stulak J, Rivera M. Conducting Virtual Simulated Skills Multiple Mini-Interviews for General Surgery Residency Interviews. J Surg Educ 2021; 78:1786-1790. [PMID: 34052143 DOI: 10.1016/j.jsurg.2021.04.013] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We describe the feasibility of transitioning simulated skills assessments during general surgery interviews from an in-person to virtual format. DESIGN/SETTING Technical and nontechnical skill multiple mini-interviews (MMIs) were performed virtually and assessed for 109 applicants during virtual general surgery interviews over 2 days at a tertiary academic medical center. RESULTS We demonstrate the feasibility of virtually assessing general surgery residency applicants' technical and non-technical skills. Using a virtual MMI format during general surgery interviews, we assessed communication, emotional intelligence, anatomical knowledge, interpretation of medical tests, knot tying, and suturing. Four tasks (communication, emotional intelligence , anatomical knowledge, and interpretation of tests) were assessed synchronously by trained general surgery interns. Applicants submitted a recording of themselves performing knot tying and suturing tasks, which were asynchronously assessed after the interview day. Applicants rated the MMI experience highly (4.3/5) via postinterview day survey and the majority of applicants felt that station objectives were met in the virtual format. CONCLUSIONS We report a successful experience implementing technical and nontechnical virtual MMIs with capacity for 120 applicants during general surgery residency interviews. In the midst of a COVID-19 pandemic, the ability to assess surgical leaners virtually is essential. Virtual skills assessments may provide a more comprehensive picture of applicants and enable residency programs to better assess residents when gathering in person is not feasible.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, Rochester, Minnesota; Mayo Clinic Multidisciplinary Simulation Center, Rochester, Minnesota
| | | | - Vicky J-H Yeh
- Mayo Clinic Department of Surgery, Rochester, Minnesota
| | | | | | - Alvaro Peña
- Mayo Clinic Department of Surgery, Rochester, Minnesota
| | - Mark Becknell
- Mayo Clinic Multidisciplinary Simulation Center, Rochester, Minnesota
| | - Florencia Que
- Mayo Clinic Department of Surgery, Rochester, Minnesota
| | - John Stulak
- Mayo Clinic Department of Cardiovascular Surgery, Rochester, Minnesota
| | - Mariela Rivera
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, Rochester, Minnesota.
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Lund S, MacArthur T, Keune J, Enger T, Martinez-Jorge J, McKenzie T, Nelson M, Olson A, Que F, Stulak J, Rivera M. Showcasing a General Surgery Residency Program During the COVID-19 Pandemic. J Surg Educ 2021; 78:e28-e34. [PMID: 34090839 PMCID: PMC8571114 DOI: 10.1016/j.jsurg.2021.04.018] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The virtual interview season has challenged general surgery residency programs to recruit applicants through the loss of visiting clerkships, tours, and time with residents. Webinars, increased informal resident and faculty sessions, and live-narrated video tours are potential solutions. This study aimed to assess the effectiveness of these elements in virtually showcasing a residency program during the virtual interview season. DESIGN/SETTING Prospective applicants to one general surgery residency program (Mayo Clinic in Rochester, Minnesota) were invited to attend six webinars: Program Overview, Simulation Education, Diversity, Resident Life, Mingle with Residents, and Last-Minute Q&A. An anonymous survey was sent to all registered participants of the webinars. Interviewees participated in a preinterview social hour with resident and faculty and a live-narrated video tour of our facilities during their interview. A second anonymous survey was sent to all interviewees. PARTICIPANTS Webinars - 33% of 159 unique registrants surveyed participated. Interviews - 46% of 109 interviewees surveyed participated. RESULTS Average satisfaction with the webinars was 9.4/10. Overall, 98% of attendees felt that the webinars gave them a "feel" for the program. Attendees found the Last-Minute Q&A webinar and Program Overview to be most useful. For resident-led webinars, 100% of attendees felt that themed break-out rooms were effective. Average satisfaction with the interviews was 4.4/5. Interviewees rated access to faculty and residents highly (4.4/5 and 4.5/5, respectively). 98% of interviewees found the live-narrated video tour helpful. CONCLUSIONS A webinar curriculum can be effective in virtual residency recruitment, as prospective applicants developed a good understanding of the resident program after participating. Further, live-narrated video tours and purposefully incorporating several avenues for informal conversations with residents and faculty can successfully address applicant concerns about virtual interviews.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic, Department of Surgery, Rochester, Minnesota
| | | | - Jonie Keune
- Mayo Clinic, Department of Surgery, Rochester, Minnesota
| | - Teresa Enger
- Mayo Clinic, Department of Surgery, Rochester, Minnesota
| | | | | | - Megan Nelson
- Mayo Clinic, Division of Trauma, Critical Care, and General Surgery, Rochester, Minnesota
| | - Angela Olson
- Mayo Clinic, Department of Plastic Surgery, Rochester, Minnesota
| | - Florencia Que
- Mayo Clinic, Department of Surgery, Rochester, Minnesota
| | - John Stulak
- Mayo Clinic, Division of Trauma, Critical Care, and General Surgery, Rochester, Minnesota
| | - Mariela Rivera
- Mayo Clinic, Department of Cardiac and Thoracic Surgery, Rochester, Minnesota.
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Lund S, Hinduja P, Stulak J, Elli E, Mishra N, Farres H, Rivera M. Impact of Elective Case Postponement Secondary to COVID-19 on General Surgery Residents' Experience: Operative Cases Logged at Three Academic Teaching Hospitals. J Surg Educ 2021; 78:1863-1867. [PMID: 34120880 PMCID: PMC8635496 DOI: 10.1016/j.jsurg.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aims to characterize changes in the total operative cases logged by general surgery residents across three residency programs. DESIGN Retrospective cohort study. De-identified case logs, divided by institution and post graduate year (PGY) level, were obtained from the general surgery training programs at three academic hospitals. Total cases logged were calculated over the pandemic period (start: beginning of residency, end: May 31st, 2020) and the control period (start: beginning of residency, end: May 31st, 2019). SETTING Three academic tertiary hospitals (Mayo Clinic - Arizona, Mayo Clinic - Florida, and Mayo Clinic - Rochester) PARTICIPANTS: All general surgery residents at these three hospitals, including 25 residents at Mayo Clinic - Arizona in both the pandemic and control period, 16 and 15 residents at Mayo Clinic - Florida in the control and pandemic period, respectively, and 81 and 77 residents at Mayo Clinic - Rochester in the control and pandemic period, respectively. RESULTS Only PGY 4 general surgery residents at Mayo Clinic - Rochester had a decrease in operative cases logged in the pandemic period (759 cases on average compared to 1010 cases, p = 0.005), with no other changes in operative cases logged noted. CONCLUSIONS While elective cases were postponed secondary to the COVID-19 pandemic for around 1 month in the spring of 2020, the decrease in elective cases did not greatly impact overall resident operative cases logged for residents in three general surgery residency programs.
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Affiliation(s)
- Sarah Lund
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Pranav Hinduja
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Enrique Elli
- Department of General Surgery, Mayo Clinic, Jacksonville, Florida
| | - Nitin Mishra
- Department of Colon and Rectal Surgery, Mayo Clinic, Phoenix, Arizona
| | - Houssam Farres
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota.
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Pahwa S, Crestanello J, Miranda W, Bernabei A, Polycarpou A, Schaff H, Dearani J, Stulak J, Pochettino A, Daly R, Lahr B, Viehman J, Greason K. Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation. J Card Surg 2021; 36:4636-4642. [PMID: 34547827 DOI: 10.1111/jocs.15996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardiectomy for postradiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction. METHODS A retrospective analysis of all patients (≥18 years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2 ± 10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at the surgical approach, the extent of resection, early mortality, and late survival. RESULTS The overall operative mortality was 10.1% (n = 10). The rate of operative mortality decreased over the study period; however, the test of the trend was not statistically significant (p = .062). Hodgkin's disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% of patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery were performed in 46% of patients. Radical resection was performed in 50% of patients, whereas 47% of patients underwent subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%), and pleural effusion (16%) were the most common postoperative complications. The overall 1, 5-, and 10-years survival was 73.6%, 53.4%, and 32.1%, respectively. Increasing age (hazard ratio, 1.044, 95% confidence interval 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model. CONCLUSION Pericardiectomy performed for radiation-associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.
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Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William Miranda
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annalisa Bernabei
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andreas Polycarpou
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Rosenbaum A, Ternus B, Stulak J, Clavell A, Schettle S, Behfar A, Jentzer J. Optimization Prior to Left Ventricular Assist Device Implantation is Associated with Reduced Risk of Severe Early Post-Implant Complications. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pahwa S, Bernabei A, Schaff H, Stulak J, Greason K, Pochettino A, Daly R, Dearani J, Bagameri G, King K, Viehman J, Crestanello J. Impact of postoperative complications after cardiac surgery on long-term survival. J Card Surg 2021; 36:2045-2052. [PMID: 33686738 DOI: 10.1111/jocs.15471] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 05/16/2020] [Revised: 01/23/2021] [Accepted: 02/06/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The impact of postoperative complications on long-term survival is not well characterized. We sought to study the prevalence of postoperative complications after cardiac surgery and their impact on long-term survival. METHODS Operative survivors (n = 26,221) who underwent coronary artery bypass grafting (CABG) (n = 13,054, 49.8%), valve surgery (n = 8667, 33.1%) or combined CABG and valve surgery (n = 4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for postoperative complications and long-term survival. Propensity-match analysis was performed between patients who did and did not have a postoperative complication. The associations between postoperative complications and survival were assessed using a Cox-proportional model. RESULTS Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 postoperative complications were analyzed. Postoperative blood product use was the commonest (n = 12,397, 47.3%), followed by atrial fibrillation (n = 8399, 32.0%), prolonged ventilation (n = 2336, 8.9%), renal failure (n = 870, 3.3%), reoperation for bleeding (n = 859, 3.3%) and pacemaker/ICD insertion (n = 795, 3.0%). Stroke (hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.36-1.77), renal failure (HR: 1.45; 95% CI: 1.33-1.58) and pneumonia (HR: 1.23; 95% CI: 1.11-1.36) had the strongest impact on long-term survival. Long-term survival decreased as the number of postoperative complications increased. CONCLUSIONS Postoperative complications after cardiac surgery significantly impact outcomes that extend beyond the postoperative period. Stroke, renal failure, and pneumonia are particularly associated with poor long-term survival.
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Affiliation(s)
| | - Annalisa Bernabei
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Pahwa S, Saran N, Pochettino A, Schaff H, Stulak J, Greason K, Daly R, Crestanello J, King K, Dearani J. Outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation. Eur J Cardiothorac Surg 2020; 59:577-585. [DOI: 10.1093/ejcts/ezaa350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/24/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Functional tricuspid regurgitation (fTR) has been amenable to tricuspid valve repair (TVr), with fewer patients needing tricuspid valve replacement (TVR). We sought to review our experience of tricuspid valve surgery for fTR.
METHODS
A retrospective analysis of adult patients (≥18 years) who underwent primary tricuspid valve surgery for fTR (n = 926; mean age 68.6 ± 12.5 years; 67% females) from January 1993 through June 2018 was conducted. There were 767 (83%) patients who underwent TVr (ring annuloplasty, 67%; purse-string annuloplasty, 33%) and 159 (17%) underwent TVR (bioprosthetic valves, 87%; mechanical valves, 13%). The median follow-up was 8.2 years [95% confidence interval (CI) 7.2–8.9 years].
RESULTS
A greater proportion of patients who underwent TVR had severe right ventricular dysfunction (P < 0.001), severe tricuspid regurgitation (P < 0.001) and congestive heart failure (P = 0.001) while the TVr cohort had a greater proportion with severe mitral valve (MV) regurgitation (P < 0.001) and concomitant cardiac procedures. Early mortality (TVR, 9% vs TVr, 3%; P = 0.004), renal failure (TVR, 10% vs TVr, 5%; P = 0.014) and hospital stay (TVR, 15 ± 15 days vs TVr, 12 ± 11 days; P < 0.001) were greater in TVR patients. The TVR cohort had worse survival [hazard ratio (HR) 1.57; 95% CI 1.23–1.99]. Multivariable analysis identified congestive heart failure (HR 1.37; 95% CI 1.10–1.72), renal failure (HR 1.79; 95% CI 1.14–2.82), previous MV surgery (HR 1.35; 95% CI 1.05–1.72) and TVR (HR 1.36; 95% CI 1.03–1.79) as independent risk factors for late mortality.
CONCLUSIONS
Tricuspid repair for fTR appears to have better early and late outcomes. Since previous MV surgery and TVR are identified as independent risk factors for late mortality, concomitant TVr at the time of index MV surgery may be considered. Early referral before the onset of advanced heart failure may improve outcomes.
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Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Katherine King
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Abdelsattar ZM, Elsisy MF, Schaff H, Stulak J, Greason K, Pochettino A, Arghami A, Rowse P, Bagameri G, Khullar V, Daly R, Cicek S, Dearani J, Crestanello J. Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis. Ann Thorac Surg 2020; 111:793-799. [PMID: 32890491 DOI: 10.1016/j.athoracsur.2020.06.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/27/2019] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compared the short- and long-term outcomes between mechanical valves, bioprostheses, and homografts. METHODS We identified all patients undergoing an operation for active complex aortic endocarditis at our institution between 2003 and 2017. We grouped patients according to those who received a mechanical valve, bioprosthesis, or homograft. We used multiple logistic regression and proportional hazards models. To minimize confounding by indication, we used marginal risk adjustment to simulate that every patient would undergo (contrary to fact) all 3 operations. RESULTS Of 159 patients with complex active endocarditis, 48 (30.2%) had a valve plus patch reconstruction, and 85 (53.4%) had a root replacement. Of all, 50 (31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and 53 (33.3%) had a homograft. The groups were similar in age, sex, body mass index, comorbid conditions, organism, abscess location, and mitral involvement (all P > .05). However, patients receiving mechanical reconstructions were more likely to have native valve endocarditis (46% vs 37.5% vs 17%; P = .005) and less likely to undergo root replacement (32% vs 28.6% vs 100%; P < .001). Marginal risk-adjusted operative mortality was lowest for mechanical valves (4.8%) and highest for homografts (16.9%; P = .041). Long-term survival after root replacement was worse with homografts than with mechanical valve conduits (adjusted hazard ratio, 2.9; P = .045). CONCLUSIONS In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes compared with homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.
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Affiliation(s)
- Zaid M Abdelsattar
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota; Department of Thoracic and Cardiovascular Surgery, Loyola University Chicago, Chicago, Illinois
| | - Mohamed F Elsisy
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell Schaff
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - John Stulak
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin Greason
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Arman Arghami
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Philip Rowse
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Vishal Khullar
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard Daly
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sertac Cicek
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph Dearani
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Juan Crestanello
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota.
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Goodman D, Schettle S, Stulak J. Air embolism following implantation of a HeartMate 3 pump. J Heart Lung Transplant 2020; 39:993-994. [PMID: 32711932 DOI: 10.1016/j.healun.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Daniel Goodman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sarah Schettle
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - John Stulak
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Schettle J, Stulak J, Schettle S. Diagnosing Suspected Left Ventricular Assist Device Driveline Damage. Radiol Technol 2020; 91:580-582. [PMID: 32606234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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37
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Jorde UP, Katz JN, Colombo PC, Stulak J, Saeed O, Egnaczyk G, Haeusslein E, McCann P, Crandall D, Franke A, Adamson R. PREVENTion of non-surgical bleeding by management of HeartMate II patients without anti-platelet therapy (PREVENT II) trial. J Heart Lung Transplant 2020; 39:838-840. [PMID: 32571737 DOI: 10.1016/j.healun.2020.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ulrich P Jorde
- Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Jason N Katz
- Department of Medicine, Duke University, Durham, North Carolina
| | - Paolo C Colombo
- Columbia University Irving Medical Center, New York, New York
| | | | - Omar Saeed
- Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
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Cowger JA, Shah P, Pagani FD, Grafton G, Stulak J, Chamogeorgakis T, Lanfear D, Nemeh H, Pinney S. Outcomes based on blood pressure in patients on continuous flow left ventricular assist device support: An Interagency Registry for Mechanically Assisted Circulatory Support analysis. J Heart Lung Transplant 2020; 39:441-453. [PMID: 31831209 PMCID: PMC7200289 DOI: 10.1016/j.healun.2019.11.016] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An optimal blood pressure (BP) range to mitigate morbidity and mortality on left ventricular assist device (LVAD) support has not been clearly defined. METHODS Average Doppler opening pressure, mean arterial pressure (MAP), and/or systolic blood pressure (SBP) were calculated in operative survivors (n = 16,155) of LVAD support in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). BP distributions were used to group patients into low (BP <25th percentile), normal (25-75th percentile), high (75th-95th percentile), and very high (>95th percentile). Associations between BP and adverse events were evaluated using Cox regression (hazard ratio[HR], 95% confidence interval). RESULTS The median (25th, 75th) MAP, Doppler, and SBP (mm Hg) during continuous flow LVAD support were 84 (77, 90), 85 (80, 92), and 99 (90, 107) mm Hg, respectively. BP had a bimodal risk association with survival. At 3 years, survival was 58% ± 1.8% in those with low MAP (≤75 mm Hg) vs 70% ± 0.9%, 71% ± 1.5%, and 63% ± 3.0% in the those with normal, high, or very high average MAP, respectively. Patients with chronically low MAP (≤75 mm Hg), Doppler (≤80 mm Hg), and SBP (<90 mm Hg) had 35%-42% higher adjusted hazards of death than patients with normal or high BP (p ≤ 0.0001). Patients with MAP >100 mm Hg, Doppler ≥105 mm Hg, and SBP ≥120 mm Hg had 17%-20% higher adjusted hazards of death than those with normal pressures (p < 0.05). In patients on axial flow LVADs, elevated SBP (HR 1.08 [95% confidence interval, 1.04-1.13] per 10 mm Hg increase) but not MAP correlated with increased incident of stroke. CONCLUSIONS In INTERMACS, BP extremes during LVAD support increase the risk for adverse events, supporting a MAP goal >75 mm Hg and <90 mm Hg. Hypotension conferred the highest risk for mortality. Excessive BP control should be avoided, and Doppler opening pressure should not be assumed to represent MAP in all patients.
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Affiliation(s)
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | | | | | | | | | - Sean Pinney
- Mount Sinai Medical Center, New York City, New York
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Pahwa S, Lee G, Tchantchaleishvili V, Weber M, Khullar V, Daly R, Schumer E, Rosenbaum A, Schettle S, Behfar A, Stulak J. Functional Outcomes Not Significantly Impacted by Hemocompatibility-Related Adverse Event Burden among Different Devices. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Schettle S, Stulak J, Rosenbaum A, Cheyne C, Ayers B, Alexis J, Gosev I. Outcomes Following Discontinuation of Warfarin in Heartmate 3 Patients: A Multi-Center Review. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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41
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Asleh R, Briasoulis A, Lerman A, Smith B, Lopez C, Pereira N, Edwards B, Stulak J, Kremers W, Clavell A, Daly R, Kushwaha S. LONG-TERM EFFECTS OF ASPIRIN ON CARDIAC ALLOGRAFT VASCULOPATHY PROGRESSION AND ADVERSE OUTCOMES AFTER HEART TRANSPLANTATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31701-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Rosenbaum A, Bohman K, Stulak J, Daly R, Klompas A, Behfar A, Yalamuri S. DUAL RVAD-ECMO CIRCUITS TO TREAT CARDIOGENIC SHOCK AND PROFOUND HYPOXEMIA DUE TO NECROTIZING LUNG INFECTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Thorac Cardiovasc Surg 2020; 159:865-896. [DOI: 10.1016/j.jtcvs.2019.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant 2020; 39:187-219. [PMID: 31983666 DOI: 10.1016/j.healun.2020.01.1329] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
| | | | - Daniel J Goldstein
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | | | - Anson Cheung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - William Holman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Charles Hoopes
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | - Ulrich P Jorde
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Nader Moazami
- Langone Medical Center, New York University, New York, NY
| | - Yoshifumi Naka
- Columbia University College of Physicians & Surgeons, New York, NY
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Salpy V Pamboukian
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | | | | | | | - John Stulak
- Mayo Clinic College of Medicine and Science, Rochester, Minn
| | | | | | | | - Stephan Schueler
- Department for Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David A D'Alessandro
- Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass
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Koerber DM, Rosenbaum AN, Olson TP, Kushwaha S, Stulak J, Maltais S, Behfar A. Exercise-induced hypoxemia predicts heart failure hospitalization and death in patients supported with left ventricular assist devices. Int J Artif Organs 2019; 43:165-172. [PMID: 31630619 DOI: 10.1177/0391398819882435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Following implantation of continuous-flow left ventricular assist devices, mechanical off-loading results in improved resting hemodynamics; however, peak exercise capacity generally does not increase substantially. This study evaluated patients supported by continuous-flow left ventricular assist devices who were invasively monitored during exercise to define parameters that underpin exercise capacity and outcomes. A review of all patients supported by continuous-flow left ventricular assist devices who underwent supine bicycle ergometry exercise testing with measurement of pulmonary gas exchange during right heart catheterization for evaluation of dyspnea at one institution between 2007 and 2018 was performed (n = 22). The primary outcome of this investigation was death or heart failure hospitalization. Although resting filling pressures were relatively preserved, resting cardiac index (Fick) was low (2.1 ± 0.5 mL/kg/min). An impaired cardiac output reserve was present in 75% of patients. On univariate modeling, patients with supine exercise-induced hypoxemia (O2 saturation <90%) experienced significantly diminished hospitalization-free survival (unadjusted hazard ratio = 11.0, confidence interval = 2.4-57.2, p = 0.003), which persisted despite adjustment for right heart catheterization peak VO2 and peak cardiac output (adjusted hazard ratio = 25, confidence interval = 3.6-322, p = 0.001). Our findings suggest that supine exercise testing provides additional prognostic utility in the continuous-flow left ventricular assist device population.
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Affiliation(s)
- Daniel M Koerber
- Van Cleve Cardiac Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas P Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sudhir Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Simon Maltais
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Atta Behfar
- Van Cleve Cardiac Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
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Rosenbaum A, Clavell A, Stulak J, Behfar A. Moderate Correlation between Central Aortic Pressure and Non-Invasive BP Monitoring in Patients Supported with Left Ventricular Assist Device Therapy. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Schettle S, Stulak J, Alnsasra H, Clavell A. Dizziness in the Heartmate III patient. Heart Lung 2019; 48:320. [PMID: 31047717 DOI: 10.1016/j.hrtlng.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Sarah Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hilmi Alnsasra
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Alfredo Clavell
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Holst K, Weber M, Tchantchaleishvili V, Dunlay S, Maltais S, Daly R, Stulak J. Hemocompatibility-Related Adverse Events: Is the Burden Different among Available Centrifugal Flow Pumps? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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49
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Koerber D, Rosenbaum A, Olson T, Kushwaha S, Stulak J, Maltais S, Behfar A. Exercise-Induced Hypoxemia Predicts Heart Failure Hospitalization and Death in Patients Supported with Left Ventricular Assist Devices. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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50
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Sajgalik P, Kim CH, Ito S, Lahr B, Wheatley C, Kushwaha S, Stulak J, Clavell A, Johnson B, Schirger J. RIGHT VENTRICULAR PRESSURE IS ASSOCIATED WITH POST-LEFT VENTRICLE ASSIST DEVICE IMPLANTATION CHANGES IN DIFFUSION CAPACITY OF LUNGS FOR CARBON MONOXIDE (DLCO). J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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