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Abstract
Early surgical intervention is critical for treatment of aortic arch aneurysms and dissections, but limited comprehensive data exist to define the optimal approach for surgical management with respect to postoperative outcomes. We conducted a systematic review of the 2 most common surgical approaches-total arch replacement and hybrid arch repair. We referenced the electronic PubMed database reporting on outcomes for these surgical approaches from inception to June 2022. Our initial search query returned a total of 2,517 records. All records were independently screened for adherence to our inclusion criteria and a total of 12 retrospective cohort studies were identified as appropriate for inclusion. Across the included studies, a total of 618 patients underwent hybrid repair, as compared to 2,104 patients who underwent total arch replacement. We found that most of the literature supported the findings of similar rates of permanent neurologic dysfunction, acute kidney injury, and short-term mortality between approaches and higher postoperative reintervention rates following hybrid repair. Reported outcomes of studies included in this review often conflicted regarding midterm and long-term survival, as well as hospital and intensive care unit length of stay following open and hybrid repair. Future studies should address midterm and long-term survival with a prospective study design.
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Affiliation(s)
- Omar M Sharaf
- College of Medicine, 12233University of Florida, Gainesville, FL, USA
| | - Patrick D Kohtz
- Department of Surgery, Division of Cardiovascular Surgery, 440202University of Florida Health, Gainesville, FL, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Cardiovascular Surgery, 440202University of Florida Health, Gainesville, FL, USA
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Gergen AK, Kohtz PD, Halpern AL, Li A, Meng X, Reece TB, Fullerton DA, Weyant MJ. Activation of Toll-Like Receptor 2 Promotes Proliferation of Human Lung Adenocarcinoma Cells. Anticancer Res 2020; 40:5361-5369. [PMID: 32988855 DOI: 10.21873/anticanres.14544] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the role of toll-like receptor 2 (TLR2) in the proliferation of human lung cancer cells and identify the signaling pathway that mediates this effect. MATERIALS AND METHODS Adenocarcinoma (A549 and H1650) and adenosquamous (H125) cells were treated with increasing doses of Pam3CSK4, a TLR2 agonist. Cell proliferation and NF-ĸB activation were evaluated. NF-ĸB was inhibited prior to treatment with Pam3CSK4 and proliferation was assessed. RESULTS TLR2 expression was significantly higher in A549 and H1650 cells compared to H125 cells (p<0.001). TLR2 stimulation induced proliferation in adenocarcinoma cells only and led to a corresponding increase in NF-ĸB activity (p<0.05). Inhibition of NF-ĸB prior to treatment with Pam3CSK4 attenuated this proliferative response. CONCLUSION TLR2 activation induced proliferation of lung adenocarcinoma cells through activation of NF-ĸB. Thus, the TLR2 signaling pathway may be a potential therapeutic target in lung adenocarcinoma.
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Affiliation(s)
- Anna K Gergen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A.
| | - Patrick D Kohtz
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - Alison L Halpern
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - Anqi Li
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - Xianzhong Meng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - Michael J Weyant
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, U.S.A
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Vigneshwar NG, Kohtz PD, Lucas MT, Bronsert M, J Weyant M, F Masood M, Itoh A, Rove JY, Reece TB, Cleveland JC, Pal JD, Fullerton DA, Aftab M. Clinical predictors of in-hospital mortality in venoarterial extracorporeal membrane oxygenation. J Card Surg 2020; 35:2512-2521. [PMID: 32789912 DOI: 10.1111/jocs.14758] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is utilized as a life-saving procedure and bridge to myocardial recovery for patients in refractory cardiogenic shock. Despite technical advancements, VA-ECMO retains high mortality. This study aims to identify the clinical predictors of in-hospital mortality after VA-ECMO to improve risk stratification for this tenuous patient population. METHODS The REgistry for Cardiogenic Shock: Utility and Efficacy of Device Therapy database is a multicenter, observational registry of ECMO patients. From 2013 to 2018, 789 patients underwent VA-ECMO. Bivariate analysis was performed on more than 300 variables regarding their association with in-hospital mortality. Logistic regression analyses were performed with variables chosen based upon clinical and statistical significance in the bivariate analysis. Tests were considered significant at a two-sided P < .05. RESULTS Although 63.5% patients were successfully weaned from VA-ECMO, in-hospital mortality was 57.9%. Nonsurvivors were older (P < .0001), had higher body mass index (P = .01), higher rates of hypertension (P = .02), coronary artery disease (P = .02), chronic obstructive pulmonary disease (P = .02), chronic liver disease (P = .008), percutaneous coronary intervention (P = .02), and surgical revascularization (P = .02). Multivariate predictors for in-hospital mortality include older age (odds ratio [OR], 1.019; P = .007), cardiac arrest (OR, 2.76; P = .006), chronic liver disease (OR, 8.87; P = .04), elevated total bilirubin (OR, 1.093; P < .0001), and the presence of a left ventricular vent (OR, 2.018; P = .03). Pre-ECMO sinus rhythm was protective (OR, 0.374; P = .006). CONCLUSIONS In a large study of recent VA-ECMO patients, in-hospital mortality remains significant, but acceptable given the severe pathology manifested in this population. Identification of pre-ECMO predictors of mortality helps stratify high-risk patients when deciding on ECMO placement, prolonged support, and prognosis.
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Affiliation(s)
- Navin G Vigneshwar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Patrick D Kohtz
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Mark T Lucas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Michael Bronsert
- Colorado Health Outcomes Program, School of Medicine, University of Colorado, Aurora, Colorado
| | - Michael J Weyant
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Muhammad F Masood
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Akinobu Itoh
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Thomas B Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Jay D Pal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
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Griffin BR, Kohtz PD, Bronsert M, Reece TB, Cleveland JC, Fullerton DA, Faubel S, Aftab M. Postoperative Complications Are Not Elevated in Well-Compensated ESRD Patients Undergoing Cardiac Surgery: End-Stage Renal Disease Cardiac Surgery Outcomes. J Surg Res 2019; 247:136-143. [PMID: 31785887 DOI: 10.1016/j.jss.2019.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/02/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) are at high risk for cardiac disease requiring surgery, and have been shown to have increased surgical risks. There have been significant improvements in ESRD management, surgical techniques, and patient selection over the past 10 y. We evaluated rates of serious postoperative outcomes in stable, well-dialyzed patients with ESRD undergoing nonemergent cardiac surgery compared to the general cardiac surgery population. METHODS In this propensity-score matched study, we evaluated 1451 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital (UCH) between 2011 and 2016. Patients with ESRD were compared to nonESRD patients. The primary outcome was a composite endpoint, including 30-d mortality, stroke, postoperative infection, and prolonged intensive care unit (ICU) length of stay (LOS). RESULTS A total of 35 patients with ESRD met inclusion criteria. These select patients were younger with few comorbidities than the nonESRD population. There were no statistically significant differences in the composite outcome between ESRD and nonESRD patients in the propensity-matched analysis (OR 0.70, CI 0.29-1.72, P = 0.44). There were no significant differences or trends for in-hospital mortality, postoperative stroke, infection, ICU LOS, or hospital LOS between the patients with and without ESRD. CONCLUSIONS Stable ESRD patients undergoing nonemergent surgery are not at increased risk of major postoperative complications when compared to those without ESRD. Well-compensated ESRD patients should not be excluded from surgical consideration.
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Affiliation(s)
- Benjamin R Griffin
- Division of Nephrology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Patrick D Kohtz
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and Surgical Outcomes and Applied Research, University of Colorado, Aurora, Colorado
| | - T Brett Reece
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - David A Fullerton
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah Faubel
- Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado.
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Kohtz PD, Halpern AL, Eldeiry MA, Hazel K, Kalatardi S, Ao L, Meng X, Reece TB, Fullerton DA, Weyant MJ. Toll-Like Receptor-4 Is a Mediator of Proliferation in Esophageal Adenocarcinoma. Ann Thorac Surg 2019; 107:233-241. [DOI: 10.1016/j.athoracsur.2018.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 02/08/2023]
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Halpern AL, Kohtz PD, Kalatardi S, Meng X, Fullerton DA, Weyant MJ. Pharmacologic Inhibition of Secretory Phospholipase A2 IIa Reduces Lung Cancer Growth In Vitro and in a Murine Model. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.095] [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: 10/28/2022]
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Eldeiry M, Ryan TJ, Kohtz PD, Meng X, Weyant MJ, Cleveland JC, Fullerton DA, Aftab M, Reece TB. Neuronal Protection through Erythropoietin Receptor and the Role of Albumin. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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