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Sainathan S, Ryan J, Mullinari L, Sanchez P. Influence of cardiac diagnosis on outcomes of pediatric heart-lung transplantation. Clin Transplant 2024; 38:e15318. [PMID: 38634157 DOI: 10.1111/ctr.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Pediatric Heart-lung transplant (HLTX) is performed for endstage congenital heart disease (CHD) with irreversible pulmonary hypertension or non-congenital heart disease (NCHD) with end-stage heart and lung disease. CHD could influence the outcomes of HTLX due to increased complexity of the operation as compared to NCHD. In this study we evaluated the influence of cardiac diagnosis on outcomes of pediatric HTLX. METHODS The UNOS database (1987-2022) was queried for primary HTLX in patients <18 years. The data were extracted for demographics, pretransplant characteristics, post-transplant outcomes, and analyzed for the impact of cardiac diagnosis on post-transplant outcomes. Standard statistical tests were used. Survival was compared using the Kaplan-Meier method. RESULTS Ninety of the 213 patients who underwent HLTX had CHD. There were no demographic differences. Heart listing status was similar but with a higher LAS score for NCHD. NCHD had higher pre-operative life support use (mechanical ventilation, inotropes or dialysis) but the use of ECMO as a bridge to transplantation was similar. Wait-list times were longer for CHD. The ischemic times were similar. Post-transplant dialysis, stroke, prolonged mechanical ventilation, and rejection were similar. Survival at 30-days, 1-year, and long-term survival at 17 years was similar. Non-survivors at 30-days post-transplant were on life support, used ECMO as a bridge, had lower wait-list times, longer ischemic times and had strokes. Non-survivors at 1-year had similar factors in addition to a higher dialysis use. CONCLUSION Cardiac diagnosis had no impact on outcomes after Pediatric HLTX. Patients on life support or ECMO before transplantation were transplanted faster but with lower survival.
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Affiliation(s)
| | - John Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, USA
| | | | - Pablo Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, USA
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Sainathan S, Ryan J, Mullinari L, Sanchez P. Lung transplantation in primary pulmonary arterial hypertension and pulmonary venous hypertension. Clin Transplant 2024; 38:e15158. [PMID: 37788166 DOI: 10.1111/ctr.15158] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES End-stage lung disease from primary pulmonary hypertension (PPHTN) and pulmonary venous-occlusive disease (PVOD) may require lung transplantation (LT). While medical therapies exist for the palliation of PPHTN, no therapies exist for PVOD. The study's objective is to compare outcomes of LT in these patients. METHODS Patients with PPHTN and PVOD who had undergone LT were identified in the UNOS database (2005-2022). Univariable analyses compared differences between groups in demographic, clinical, and post-transplant outcomes. Multivariable logistic regression examined the association between the diagnosis group and survival. Overall survival time between groups was compared using the Kaplan-Meier method. RESULTS Six hundred and ninety-six PPHTN and 78 PVOD patients underwent LT during the study period. Patients with PVOD had lower pulmonary artery mean pressure (47 vs. 53 mmHg, p < .001), but higher cardiac output (4.51 vs. 4.31 L/min, p = .04). PVOD patients were more likely to receive lungs from donation after cardiac death donors (7.7 vs. 2.9%, p = .04). There were no differences in postoperative complications or length of stay. PVOD was associated with superior survival at 30-day (100 vs. 93%, p = .02) and 90-day post-transplant (93 vs. 83%, p = .03), but not at later time points. In multivariable analyses, PVOD and brain death donor use were associated with better survival up to 90-day mark. CONCLUSIONS Patients undergoing LT for PVOD had better initial survival, which disappeared after 1 year of transplantation. Donation after circulatory death donor use had a short-term survival disadvantage.
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Affiliation(s)
- Sandeep Sainathan
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - John Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leonardo Mullinari
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Pablo Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Kuhn JE, Pareja Zabala MC, Chavez MM, Almodóvar M, Mulinari LA, Sainathan S, de Rivero Vaccari JP, Wang KK, Muñoz Pareja JC. Utility of Brain Injury Biomarkers in Children With Congenital Heart Disease Undergoing Cardiac Surgery. Pediatr Neurol 2023; 148:44-53. [PMID: 37657124 DOI: 10.1016/j.pediatrneurol.2023.06.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) affects roughly 40,000 children annually. Despite advancements, children undergoing surgery for CHD are at an increased risk for adverse neurological outcomes. At present, there is no gold standard for the diagnosis of cerebral injury during the perioperative period. OBJECTIVE To determine the utility of brain injury biomarkers in children undergoing cardiac surgery. METHODS We searched PUBMED, EMBASE, LILACS, EBSCO, ClinicalTrials.gov, Cochrane Databases, and OVID interface to search MEDLINE through July 2021 and assessed the literature following the snowball method. The search terms used were "congenital heart disease," "cardiopulmonary bypass," "biomarkers," "diagnosis," "prognosis," and "children." No language or publication date restrictions were used. Papers studying inflammatory and imaging biomarkers were excluded. The risk of bias, strengths, and limitations of the study were reported. Study was registered in PROSPERO ID: CRD42021258385. RESULTS A total of 1449 articles were retrieved, and 27 were included. Eight neurological biomarkers were examined. Outcomes assessed included prognosis of poor neurological outcome, mortality, readmission, and diagnosis of brain injury. Results from these studies support that significant perioperative elevations in brain injury biomarkers in cerebrospinal fluid and serum, including S100B, GFAP, NSE, and activin A, may be diagnostic of real-time brain injury and serve as an independent predictor of adverse neurological outcomes in patients with CHD undergoing cardiopulmonary bypass. CONCLUSIONS There are limited homogeneous data in the field, limiting the generalizability and comparability of the results. Further large-scale longitudinal studies addressing neurological biomarkers in children undergoing CHD corrective surgery are required to support the routine use of neuronal biomarkers in this population.
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Affiliation(s)
- Jessica E Kuhn
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Maria Mateo Chavez
- Knowledge and Research Evaluation Unit, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Melvin Almodóvar
- Division of Pediatric Cardiology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Leonardo A Mulinari
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sandeep Sainathan
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Kevin K Wang
- Department of Emergency Medicine, Morehouse University, School of Medicine, Atlanta, Georgia; Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia
| | - Jennifer C Muñoz Pareja
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida; Division of Pediatric Critical Care, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.
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Said SM, Hiremath G, Aggarwal V, Bass J, Sainathan S, Salem MI, Narasimhan S. Early Concerning Outcomes for the Edwards Inspiris Resilia Bioprosthesis in the Pulmonary Position. Ann Thorac Surg 2023; 115:1000-1007. [PMID: 36174775 DOI: 10.1016/j.athoracsur.2022.09.026] [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: 06/08/2022] [Revised: 08/06/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Inspiris Resilia (Edwards Lifesciences LLC) bioprosthesis has gained widespread use in the aortic position; however no robust data are available about its use in the pulmonary position. METHODS We reviewed our outcomes for the Inspiris Resilia in the pulmonary position between August 2019 and October 2021. RESULTS Twenty-seven patients (15 female patients [56%]; mean age, 22.26 ± 14.99 years) were included. The most common original pathology was tetralogy of Fallot (13 patients, 48%). Five patients (18.5%) had prior transcatheter interventions. The mean right ventricular end-diastolic volume index was 164.25 ± 45.1 mL/m2. Sternotomy or repeat sternotomy was the most common approach (21 patients, 77.8%). The standard technique for pulmonary valve replacement was used in 22 patients (81.5%), whereas the prosthesis was implanted as a conduit in the remaining 5 (18.5%). Trivial to mild prosthetic regurgitation was present in 6 patients (22.2%) at the time of discharge. There was no early mortality. Follow-up was complete in all patients (mean, 16 ± 8 months), with no late mortality or late reoperations. New prosthetic regurgitation developed in 13 patients (48%), all of whom underwent replacement with the standard surgical technique. No regurgitation occurred in the conduit cases. This progressed to moderate regurgitation in 6 patients (22%) and severe in 3 (11%). Three patients (11%) underwent transcatheter valve-in-valve after their surgical pulmonary valve replacement. CONCLUSIONS The early data regarding the Inspiris Resilia bioprosthesis use in the pulmonary position is concerning. The prosthesis design may not be suitable for low-pressure circulation, or modification of its implantation technique may be needed.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York; Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
| | - John Bass
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Mahmoud I Salem
- Department of Cardiothoracic Surgery, Port Said University, Port Said, Egypt
| | - Shanti Narasimhan
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
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Said SM, Ricciardi G, Smith BJ, Sainathan S, Narasimhan SL. Repair of Partial Anomalous Pulmonary Venous Connection to the Azygous Vein via Right Thoracotomy. World J Pediatr Congenit Heart Surg 2023; 14:227-230. [PMID: 36952283 DOI: 10.1177/21501351221145175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A 21-month-old boy was diagnosed with partial anomalous pulmonary venous connection, with the right upper pulmonary veins draining to the superior vena cava (SVC). Intraoperatively, it became evident that the right upper pulmonary veins connected to the azygous vein before draining to the SVC.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Maria Fareri Children's Hospital, Department of Surgery, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Gabriella Ricciardi
- Department of Cardiac Surgery, Lille University Hospital, 27023University of Lille, Lille, France
| | - Benjamin J Smith
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Shanti L Narasimhan
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
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6
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Harano T, Sheth M, Sasaki K, Yu J, Wightman SC, Atay SM, Sainathan S, Kim AW. Heart transplantation for pediatric foreign nationals in the United States. Clin Transplant 2023; 37:e14900. [PMID: 36587308 DOI: 10.1111/ctr.14900] [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: 11/04/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study aimed to clarify survival outcomes, waitlist mortality, and waitlist days of heart transplantation of pediatric foreign nationals compared to pediatric United States (US) citizens. METHODS We retrieved data from March 2012 to June 2021 in the United Network Organ Sharing (UNOS) registry. RESULTS Of 5857 pediatric patients newly waitlisted, 133 (2.27%) patients were non-US citizen/non-US residents (non-citizen non-resident [NCNR]). Patients with congenital heart disease were higher in the US citizen group than in the NCNR group (51.9% vs. 22.6%, p < .001); 76.7% of patients in the NCNR group (102/133) had cardiomyopathy. Of the 133 NCNRs, 111 patients (83.5%) underwent heart transplantation, which was significantly higher than that in the US citizen group (68.6%, p < .001). The median waitlist time was 71 days (IQR, 22-172 days) in the NCNR group and 74 days (29-184 days) in the US citizen group (p = .48). Survival after heart transplant was significantly better in the NCNR group than in the US citizen group (n = 3982; logrank test p = .015). CONCLUSIONS Heart transplantation for pediatric foreign nationals was mostly indicated for cardiomyopathy, and their transplant rate was significantly higher than that in the US citizen group, with better survival outcomes. The better survival outcomes in the NCNR group compared to the US citizen group can likely be attributed to the differing diagnoses for which transplantation was performed.
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Affiliation(s)
- Takashi Harano
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Megha Sheth
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Jeremy Yu
- Department of Psychiatry and Behavioral Sciences & SC CTSI Biostatistics, Epidemiology, and Research Design, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sandeep Sainathan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami, Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Sainathan S, Ryan J, Said S, Mullinari L, Sanchez P. Outcomes of heart-lung transplantation in Eisenmenger syndrome compared to primary pulmonary hypertension. Asian Cardiovasc Thorac Ann 2023; 31:180-187. [PMID: 36659858 DOI: 10.1177/02184923231151551] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Heart-Lung Transplantation (HLTX) is required both in primary pulmonary hypertension (PPH) and Eisenmenger syndrome (ES) when there is associated end-stage heart disease. Although PPH is associated with an otherwise structurally normal heart, ES is associated with congenital heart defects, which may increase the complexity of the operation. This study analyzes if the diagnosis (PPH vs. ES) is related to short-term outcomes after HLTX. METHODS Patients ≥18 years of age with PPH and ES who underwent HLTX were identified in the United Network for Organ Sharing database from 2005 to 2021. Patients were propensity score matched on heart and lung listing status at the time of transplant. Univariable, multivariable, and Kaplan-Meir survival analyses were performed. RESULTS The unmatched cohort had 128 PPH and 44 ES patients, and the matched cohort had 44 patients in each group. PPH patients had lower waitlist times and PA pressures but higher FEV1, heart, and lung listing status and ECMO bridge. There were no differences in immediate postoperative outcomes such as dialysis, stroke, and airway dehiscence. PPH patients had a higher treatment rejection in the first year. The 30-day, 1-year, and 3-year survival were better in the PPH group. However, a landmark analysis excluding deaths within 30 days eliminated differences in survival between the groups. Post-transplant dialysis and postoperative mechanical ventilation >5 days were risk factors for 1-year mortality in ES. CONCLUSION The short-term outcomes of HLTX are inferior in ES compared to PPH and much of the attrition in ES occurs in the immediate postoperative period.
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Affiliation(s)
- Sandeep Sainathan
- Division of Cardiothoracic Surgery, University of Miami, Miami, FL, USA
| | - John Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sameh Said
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Pablo Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Said SM, Greathouse KC, McCarthy CM, Brown N, Kumar S, Salem MI, Kloesel B, Sainathan S. Safety and Efficacy of Right Axillary Thoracotomy for Repair of Congenital Heart Defects in Children. World J Pediatr Congenit Heart Surg 2023; 14:47-54. [PMID: 36847761 DOI: 10.1177/21501351221127283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Minimally invasive repair of congenital heart defects in children has not gained wide popularity yet compared to minimally invasive approaches in adults. We sought to review our experience with this approach in children. METHODS This study included a total of 37 children (24 girls, 64.9%) with a mean age of 6.5 ± 5.1 years, who underwent vertical axillary right minithoracotomy for repair of a variety of congenital heart defects between May 2020 and June 2022. RESULTS The mean weight of these children was 25.66 ± 18.3 kg. Trisomy 21 syndrome was present in 3 patients (8.1%). The most common congenital heart defects that were repaired via this approach were atrial septal defects (secundum in 11 patients, 29.7%; primum in 5, 13.5%; and unroofed coronary sinus in 1, 2.7%). Twelve patients (32.4%) underwent repair of partial anomalous pulmonary venous connections with or without sinus venosus defects, while 4 patients (10.8%) underwent closure of membranous ventricular septal defects. Mitral valve repair, resection of cor triatriatum dexter, epicardial pacemaker placement, and myxoma resection occurred in 1 patient (2.7%) each. No early mortality or reoperations. All patients were extubated in the operating room, and the mean length of hospital stay was 3.3 ± 2.04 days. Follow-up was complete (mean 7 ± 5 months). No late mortality or reoperations. One patient required epicardial pacemaker placement due to sinus node dysfunction 5 months after surgery. CONCLUSIONS Vertical axillary right thoracotomy is a cosmetically superior approach that is safe and effective for repair of a variety of congenital heart defects in children.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Maria Fareri Children's Hospital, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA.,Faculty of Medicine, 54562Alexandria University, Alexandria, Egypt
| | - Kristin C Greathouse
- M Health Fairview Health System, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Christina M McCarthy
- M Health Fairview Health System, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Nicholas Brown
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Masonic Children's Hospital, 5635University of Minnesota, Minneapolis, MN, USA
| | - Sacha Kumar
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Masonic Children's Hospital, 5635University of Minnesota, Minneapolis, MN, USA
| | - Mahmoud I Salem
- Department of Cardiothoracic Surgery, 289164Port Said University, Port Said, Egypt
| | - Benjamin Kloesel
- Department of Anesthesiology, 5635University of Minnesota, Minneapolis, MN, USA
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, 12235University of Miami, Miller School of Medicine, Miami, FL, USA
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Sainathan S, Said S, Tsujimoto T, Lin FC, Mullinari L, Sharma M. Impact of occurrence of cardiac arrest in the donor on long-term outcomes of pediatric heart transplantation. J Card Surg 2022; 37:4875-4882. [PMID: 36345684 DOI: 10.1111/jocs.17143] [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: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The impact of cardiac arrest in the donor on long-term outcomes of pediatric heart transplantation has not been studied. METHODS The UNOS database was queried for primary pediatric heart transplantation (1999-2020). The cohort was divided into recipients who received a cardiac allograft from a donor who had a cardiac arrest (CA) versus a donor who did not (NCA). Univariable and multivariable analysis was done to compare recipient outcomes, followed by survival analysis using the Kaplan-Meier method. RESULTS A total of 7300 patients underwent heart transplantation, of which 579 (7.9%) patients belonged to the CA group. The CA group was younger (median 3 vs. 5 years, p < .001), male (51% vs. 47%, p = .03), and smaller in weight (13 vs. 17 kg, p < .001) and height (101 vs. 109 cm, p < .001) than the NCA group. The groups were similar in recipient heart failure diagnosis and blood type. The CA donors were younger (3 vs. 6 years, p < .001) versus nonwhite (48% vs. 45%, p = .003) and died from drowning and asphyxiation compared to blunt injury and intracranial hemorrhage in the NCA group. The left-ventricular ejection fraction was similar between the groups. There was no difference in VAD and ECMO use before the transplant. The listing status, waitlist days, and allograft ischemic times were similar. Posttransplant morbidity such as stroke, dialysis, pacemaker implantation, and treated rejection were similar. Donor cardiac arrest (hazard ratio = 0.93, p = .5) was not an independent predictor of mortality on multivariable analysis. There was no survival difference even beyond 20 years of follow-up between the groups (p = .88). CONCLUSION The occurrence of donor cardiac arrest has no impact on long-term survival in pediatric heart transplant recipients.
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Affiliation(s)
- Sandeep Sainathan
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Sameh Said
- Division of Cardiothoracic Surgery, Maria Fareri Children's Hospital, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Tamy Tsujimoto
- Department of Biostatistics, Gilling School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gilling School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Leonardo Mullinari
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Mahesh Sharma
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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10
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Sainathan S, Mullinari L. Is coronary artery transfer still the jugular for the arterial switch operation? J Card Surg 2022; 37:3825-3826. [PMID: 36116103 DOI: 10.1111/jocs.16901] [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: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
The outcomes of the arterial switch operation have improved over a period of time with the elimination of coronary artery anatomy as a risk factor for operative mortality in some series. However, cumulatively, when all the series published so far are analyzed, two coronary variations, namely the single sinus coronary artery origin and the intramural type, persist as risk factors for an adverse operative outcome.
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Affiliation(s)
- Sandeep Sainathan
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Leonardo Mullinari
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
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11
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Sainathan S, Mullinari L. Vasoactive-inotropic score: A dilatory predictor of adverse short-term postoperative outcomes in pediatric patients undergoing cardiac surgical procedures with cardiopulmonary bypass. J Card Surg 2022; 37:3662-3663. [PMID: 36069155 DOI: 10.1111/jocs.16917] [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: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sandeep Sainathan
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Leonardo Mullinari
- Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
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12
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Sainathan S, Said SM, Agala CB, Mullinari L, Sharma M. National outcomes of the Fontan operation with endocardial cushion defect. J Card Surg 2022; 37:3151-3158. [PMID: 35788993 DOI: 10.1111/jocs.16742] [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: 01/16/2022] [Revised: 04/22/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The traditional outcomes of the Fontan operation (FO) in endocardial cushion defect (ECD) patients have been suboptimal. Previous studies have been limited by the smaller number of ECD patients, longer study period with an era effect, and do not directly compare short-term outcomes of FO in ECD patients with non-ECD patients. Our study aims to address these shortcomings. METHODS A retrospective analysis of the Kids Inpatient Database (2009, 2012, and 2016) for the FO was done. The groups were divided into those who underwent FO with ECD as compared to non-ECD diagnosis. The data were abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. RESULTS Three thousand three hundred eighty patients underwent the FO of which 360 patients (11%) were FO-ECD. ECD patients were more likely to have Down syndrome, Heterotaxy syndrome, transposition/DORV, and TAPVR as compared to non-ECD patients. FO-ECD had a higher discharge-mortality (2.84% vs. 0.45%, p = .04). The length of stay (16 vs. 13 days, p = .05) and total charges incurred ($283, 280 vs. $234, 106, p = .03) for the admission were higher in the FO-ECD as compared to non-ECD patients. In multivariable analysis, ECD diagnosis, cardiac arrest, acute kidney injury, and postoperative hemorrhage were predictors of mortality. CONCLUSION Contemporary outcomes for FO are excellent with very low overall operative mortality. However, the outcomes in ECD patients are inferior with higher operative mortality than in non-ECD patients. The occurrence of postoperation complications and a diagnosis of ECD were predictive of a negative outcome.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Sameh M Said
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chris B Agala
- Department of Surgery/Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leonardo Mullinari
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Mahesh Sharma
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Sainathan S, Monge M, Schettino C, Mulinari L. HeartMate 3 VAD in a single-ventricle patient palliated with a superior-cavopulmonary anastomosis. Ann Thorac Surg 2022; 115:e121-e123. [PMID: 35472409 DOI: 10.1016/j.athoracsur.2022.04.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 11/15/2022]
Abstract
We report a 9-year-old, 25 kilograms child with failing single-ventricle palliation with a superior-cavopulmonary anastomosis successfully supported with a HeartMate 3™ ventricular assist device as a bridge-to-transplant.
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Affiliation(s)
| | - Michael Monge
- Northwestern University, Section of Pediatric cardiothoracic surgery
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14
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Challa AS, Sainathan S. Extracorporeal membrane oxygenation (ECMO): Can we do it ourselves? J Card Surg 2022; 37:2015-2016. [PMID: 35445766 PMCID: PMC9115161 DOI: 10.1111/jocs.16527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a selectively available therapeutic option, generally available in a large‐size referral healthcare system. In a single‐center experience of the use of venovenous ECMO for COVID‐19 ARDS in a medium‐size healthcare system during the pandemic, West et al. in their study have convincingly demonstrated that ECMO can become a broadly available therapeutic option without compromising quality.
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Affiliation(s)
- Akshara Sree Challa
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sandeep Sainathan
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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Sainathan S, Agala CB, Said SM, Mulinari L, Sharma MS. National Fontan Operation short-term outcomes at or below 2-years-of-age compared to older than 2-years-of-age. J Card Surg 2022; 37:1567-1573. [PMID: 35324033 DOI: 10.1111/jocs.16424] [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: 11/22/2021] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Opinion is divided about optimal early timing of the Fontan Operation (FO). While some studies have suggested 3 years-of-age, others have shown good outcomes below 2 years-of-age. We analyzed the impact of age ≤2 years as compared age >2 years on short-term outcome of the FO using a large national database. METHODS A retrospective analysis of the Kids Inpatient Database (2009-16) for the FO was done. The groups were divided into those who underwent FO at age ≤2 years (Early FO [EF]) as compared to age >2 years (Late FO [LF]). The data was abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. RESULTS A total of 3381 patients underwent FO during this period of which 1482 (44%) were EF. The mean ages of the EF and LF were 1.6 and 4.3, respectively (p < .001). LF were more likely to be non-White, female, and have Heterotaxy syndrome. HLHS was more common in EF. There was no difference in the discharge mortality, length of stay, disposition (majority went home), and mean total charges incurred. The overall discharge mortality was low at 0.7% (24/3381). In multivariate analysis: cardiac arrest, acute kidney injury, mechanical ventilation >96 h, endocardial cushion defect and non-White ethnicity were predictors of a mortality and not age. CONCLUSION Contemporary outcomes for FO are excellent with equivalent short-term outcomes in both the age groups. Occurrence of postoperative complications, non-White ethnicity and endocardial cushion defect diagnosis were predictive of a negative outcome.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Coral Gables, Florida, USA.,Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chris B Agala
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sameh M Said
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Leonardo Mulinari
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Coral Gables, Florida, USA
| | - Mahesh S Sharma
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Sainathan S, Mulinari L. Coarctation of the aorta with aortic arch hypoplasia: Tackle from the front or the side? J Card Surg 2022; 37:1633-1634. [PMID: 35315138 DOI: 10.1111/jocs.16434] [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: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
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17
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Sainathan S, Mulinari L. A game of Whack‐A‐Mole: Closing multiple ventricular septal defects. J Card Surg 2022; 37:1377-1378. [DOI: 10.1111/jocs.16350] [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: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sandeep Sainathan
- Miller School of Medicine, University of Miami Surgery/Pediatric and Congenital Cardiac Surgery Miami Florida USA
| | - Leonardo Mulinari
- Miller School of Medicine, University of Miami Surgery/Pediatric and Congenital Cardiac Surgery Miami Florida USA
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18
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Said SM, Sainathan S, Miranda C, Aggarwal V, Bass J. Sinus Node Recovery after Explantation of Amplatzer Septal Occluder: A Word of Caution. JTCVS Tech 2022; 12:166-169. [PMID: 35403052 PMCID: PMC8987339 DOI: 10.1016/j.xjtc.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sameh M. Said
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
- Address for reprints: Sameh M. Said, MBBCh, MD, FACS, Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave S, Academic Office Building, 521, Minneapolis, MN 55454.
| | - Sandeep Sainathan
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
| | | | - Varun Aggarwal
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
| | - John Bass
- Division of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
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Sainathan S, Salerno TA. Commentary: Novel oral anticoagulants effectuating novel applications in cardiac surgery! Semin Thorac Cardiovasc Surg 2021; 35:275-276. [PMID: 34933102 DOI: 10.1053/j.semtcvs.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tomas A Salerno
- the Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, and the Department of Cardiac Surgery, Jackson Memorial Hospital, Miami, Florida.
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20
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Sainathan S, Salerno TA. Commentary: Optimal left ventricular assist device duration in bridge to transplantation: Do we have a choice now, or is it a moot point? JTCVS Open 2021; 8:121-122. [PMID: 36004069 PMCID: PMC9390744 DOI: 10.1016/j.xjon.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sandeep Sainathan
- Division of Congenital Heart Surgery, University of Miami Miller School of Medicine, Miami, Fla
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Tomas A. Salerno
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Fla
- Department of Cardiac Surgery Jackson Memorial Hospital, Miami, Fla
- Address for reprints: Tomas A. Salerno, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136.
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21
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Said SM, Sainathan S. Modified Starnes procedure as a bridge to 2-ventricle repair in neonatal Ebstein's anomaly: A paradigm shift. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34817936 DOI: 10.1510/mmcts.2021.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Severe tricuspid valve regurgitation secondary to Ebstein's anomaly represents several challenges in neonates. It can result in significant respiratory and/or hemodynamic compromise that mandates urgent interventions. When conservative management fails, 2 surgical options are available: tricuspid valve repair or single ventricle palliation. The overall results of neonatal tricuspid valve repair are unsatisfactory especially in sick neonates and those with preoperative hemodynamic instability. Single ventricle palliation utilizing the Starnes procedure with right ventricular exclusion provides a quicker way to improve hemodynamics and allows rapid decompression of the right ventricle but carries the long-term disadvantages of the single ventricle pathway. We were recently faced with a challenging case of neonatal Ebstein's anomaly resulting in severe tricuspid valve regurgitation (TR) and significant hemodynamic and respiratory instability. We performed an initial stage I palliation with a modified Starnes' procedure, which allowed stabilization and rapid recovery of the patient to be followed 5 months later with conversion to 2-ventricle repair using the cone technique. We believe combining these 2 strategies for suitable neonatal candidates may be a useful technique that should be considered in the algorithm for neonatal Ebstein's anomaly.
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Affiliation(s)
- Sameh M Said
- University of Minnesota, Masonic Children's Hospital 2450 Riverside Ave S, East Building, MB 539, Minneapolis, MN 55454
| | - Sandeep Sainathan
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, 55454
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22
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Sainathan S. Commentary: The thoracic nutcracker syndrome. JTCVS Tech 2021; 8:129-131. [PMID: 34401832 PMCID: PMC8350881 DOI: 10.1016/j.xjtc.2021.05.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sandeep Sainathan
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Abstract
We present a case of a premature infant who had an initial diagnosis of an innominate artery compression syndrome. This was approached by a median sternotomy for an aortopexy. However, the patient was found to have a distal tracheal stenosis due to a tracheal cartilage deficiency and was treated by a tracheal resection and primary anastamosis.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahesh Sharma
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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24
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Sainathan S, Ryan J, Sharma M, Harano T, Morell V, Sanchez P. Outcome of Bridge to Lung Transplantation With Extracorporeal Membrane Oxygenation in Pediatric Patients 12 Years and Older. Ann Thorac Surg 2020; 112:1083-1088. [PMID: 33217402 DOI: 10.1016/j.athoracsur.2020.08.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/24/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a reluctance to using extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation in the pediatric population. Pediatric patients between ages 12 and 18 years are eligible for acuity-based lung transplantation using the Lung Allocation Score and may be suitable for adult allografts, increasing the donor pool and thus leading to a successful bridge to lung transplantation. METHODS The United Network for Organ Sharing dataset was queried for primary lung transplantation in pediatric patients (12-18 years) from 2005 to 2016. Groups were divided into those who were on ECMO (bridged [BG]) and not on ECMO (nonbridged [NBG]) at the time of listing for lung transplant. RESULTS The groups comprised 16 BG and 375 NBG patients. Fourteen BG patients (88%) survived the first 30 days. One-year (83.3% vs 86.2%, P = .78) and 3-year (66.7% vs 55.1%, P = .57) survivals were similar in the BG and NBG groups, respectively. Donors in the BG group were more likely to be adults. The median wait-list times were shorter (10.5 [interquartile range {IQR}, 11] vs 93 [IQR, 221] days, P < .001), with a higher Lung Allocation Score (89.8 vs 36.6, P < .001) and similar median ischemic times (5.19 [IQR, 2.32] vs 5.34 [IQR, 1.92] hours, P = .85) in the BG group compared with the NBG group. The median post-transplant length of stay was longer in the BG group (33 [IQR, 31] vs 17 [IQR, 12] days, P = .007) and was the only factor predictive of 3-year mortality. Longer wait-list time had a higher mortality in the BG group. CONCLUSIONS ECMO as a bridge to lung transplantation is a reasonable strategy in pediatric patients aged ≥ 12 years with acceptable operative mortality and similar 1- and 3-year survival compared with nonbridged patients despite higher acuity. Bridged patients were more likely to receive adult donor lungs.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Chapel Hill, Chapel Hill, North Carolina.
| | - John Ryan
- Department of Cardiothoracic Surgery, Division of Lung Transplantation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mahesh Sharma
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Takashi Harano
- Department of Cardiothoracic Surgery, Division of Lung Transplantation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Victor Morell
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pablo Sanchez
- Department of Cardiothoracic Surgery, Division of Lung Transplantation, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Abstract
Ebstein’s anomaly (EA) is a rare congenital cardiac anomaly. It is a disease at a minimum of the tricuspid valve (TV) and the right ventricular myocardium. Presentation varies from a severe symptomatic form during the neonatal period to an incidental detection later in life due to the wide morphological variation of the condition. The neonatal presentation can be severe and every attempt should be made at medical management ideally into infancy and early childhood. Neonates not eligible or failing medical management should be surgically managed either with a single ventricle palliative approach or a more desirable biventricular repair with a neonatal TV valvuloplasty. Some neonates initially committed to a single ventricle pathway may be converted to a biventricular repair by a delayed TV valvuloplasty. The da Silva Cone repair has become the valvuloplasty of choice especially beyond the neonatal period and can be applied to a wide morphological variation of the condition with good long-term durability. If the chance of a successful TV valvuloplasty is high, it should be offered early in childhood to prevent further cardiac dilation. Adding a Bidirectional Glenn to a valvuloplasty may help salvage marginal risk patients or marginally repairable valves. If valve replacement is the only option, a bioprosthetic valve should be used as it is less thrombogenic especially with marginal right ventricular function. Heart transplantation should be considered in patients with associated left ventricular dysfunction.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | - Jose Pedro da Silva
- Department of Cardio-thoracic surgery, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Absi M, Sainathan S, Beasley G, Boston U. Use of a novel antiplatelet agent cangrelor in an infant supported with a ventricular assist device. Artif Organs 2020; 44:532-533. [PMID: 31957028 DOI: 10.1111/aor.13613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/09/2019] [Accepted: 11/18/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Mohammed Absi
- Pediatric Cardiology, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Sandeep Sainathan
- Pediatric Cardiothoracic Surgery Department, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Gary Beasley
- Pediatric Cardiology, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Umar Boston
- Pediatric Cardiothoracic Surgery Department, Le Bonheur Children's Hospital, Memphis, TN, USA
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27
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Bayle KM, Boston U, Sainathan S, Naik R, Knott-Craig CJ. Ross-Konno Operation in an Infant With a Quadricuspid Pulmonary Valve and Anomalous Aortic Origin of the Right Coronary Artery. Ann Thorac Surg 2019; 109:e41-e43. [PMID: 31181204 DOI: 10.1016/j.athoracsur.2019.04.061] [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: 02/04/2019] [Revised: 02/27/2019] [Accepted: 04/01/2019] [Indexed: 11/19/2022]
Abstract
Anomalous aortic origin of the right coronary artery from the left aortic sinus is a rare congenital anomaly that is generally repaired during adolescence when the condition is associated with symptoms. It is rarely diagnosed in infancy. Similarly, a quadricuspid pulmonary valve is also a rare finding, and there are scant data to evaluate whether this malformation of the pulmonary valve is suitable to be used for a Ross operation. This report describes a case in which both these anomalies coexisted in an infant who underwent a successful Ross-Konno operation.
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Affiliation(s)
- Ken-Michael Bayle
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital and the University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Umar Boston
- Division of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and the University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Sandeep Sainathan
- Division of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and the University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Ronak Naik
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital and the University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Christopher J Knott-Craig
- Division of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and the University of Tennessee Health Sciences Center, Memphis, Tennessee.
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28
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Duong SQ, Godown J, Soslow JH, Thurm C, Hall M, Sainathan S, Morell VO, Dodd DA, Feingold B. Increased mortality, morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements. J Thorac Cardiovasc Surg 2019; 157:730-740.e11. [PMID: 30669235 PMCID: PMC6865268 DOI: 10.1016/j.jtcvs.2018.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/22/2018] [Accepted: 11/04/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Identify pediatric heart transplant (HT) recipients with heterotaxy and other complex arrangements of cardiac situs (heterotaxy/situs anomaly) and compare mortality, morbidities, length of stay (LOS), and costs to recipients with congenital heart disease without heterotaxy/situs anomaly. METHODS Using linked registry data (2001-2016), we identified 186 HT recipients with heterotaxy/situs anomaly and 1254 with congenital heart disease without heterotaxy/situs anomaly. We compared post-HT outcomes in univariable and multivariable time-to-event analyses. LOS and cost from HT to discharge were compared using Wilcoxon rank-sum tests. Sensitivity analyses were performed using stricter heterotaxy/situs anomaly group inclusion criteria and through propensity matching. RESULTS HT recipients with heterotaxy/situs anomaly were older (median age, 5.1 vs 1.6 years; P < .001) and more often black, Asian, Hispanic, or "other" nonwhite (54% vs 32%; P < .001). Heterotaxy/situs anomaly was independently associated with increased mortality (hazard ratio, 1.58; 95% confidence interval, 1.19-2.09; P = .002), even among 6-month survivors (hazard ratio, 1.86; 95% confidence interval, 1.09-3.16; P = .021). Heterotaxy/situs anomaly recipients more commonly required dialysis (odds ratio, 2.58; 95% confidence interval, 1.51-4.42; P = .001) and cardiac reoperation (odds ratio, 1.91; 95% confidence interval, 1.17-3.11; P = .010) before discharge. They had longer ischemic times (19.2 additional minutes [range, 10.9-27.5 minutes]; P < .001), post-HT intensive care unit LOS (16 vs 13 days; P = .012), and hospital LOS (26 vs 23 days; P = .005). Post-HT hospitalization costs were also greater ($447,604 vs $379,357; P = .001). CONCLUSIONS Heterotaxy and other complex arrangements of cardiac situs are associated with increased mortality, postoperative complications, LOS, and costs after HT. Although increased surgical complexity can account for many of these differences, inferior late survival is not well explained and deserves further study.
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Affiliation(s)
- Son Q Duong
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Cary Thurm
- Children's Hospital Association, Lenexa, Kan
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kan
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Victor O Morell
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Debra A Dodd
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Brian Feingold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
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Ziegler LA, Sainathan S, Morell VO, Sharma MS. Total Artificial Heart as Rescue Therapy for Primary Graft Failure in an Infant. Ann Thorac Surg 2018; 105:e151-e153. [DOI: 10.1016/j.athoracsur.2017.10.049] [Citation(s) in RCA: 2] [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] [Received: 10/05/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 10/17/2022]
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30
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Sainathan S, Monge M, Eltayeb O. Successful Repair of a Ruptured Mycotic Aortic Aneurysm in a Pediatric Patient with Deep Hypothermic Circulatory Arrest. Am Surg 2018; 84:e77-e79. [PMID: 30454486] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sandeep Sainathan
- Department of Pediatric Cardiothoracic Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University, Chicago, Illinois, USA
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31
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Sainathan S, Monge M, Eltayeb O. Successful Repair of a Ruptured Mycotic Aortic Aneurysm in a Pediatric Patient with Deep Hypothermic Circulatory Arrest. Am Surg 2018. [DOI: 10.1177/000313481808400214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sandeep Sainathan
- Department of Pediatric Cardiothoracic Surgery Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois
| | - Michael Monge
- Department of Pediatric Cardiothoracic Surgery Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois
| | - Osama Eltayeb
- Department of Pediatric Cardiothoracic Surgery Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois
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32
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Tripathi R, Sainathan S, Ziganshin BA, Elefteriades JA. Thoracic Aortic Aneurysm from Chronic Antiestrogen Therapy. Int J Angiol 2017; 26:60-63. [PMID: 28255218 DOI: 10.1055/s-0036-1583522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/11/2016] [Accepted: 03/24/2016] [Indexed: 01/03/2023] Open
Abstract
Aortic aneurysms are a common but often undetected pathology prevalent in the population. They are often detected as incidental findings on imaging studies performed for unrelated pathologies. Estrogens have been shown to exert a protective influence on aortic tissue. Pharmacological agents blocking the actions of estrogens may thus be implicated in causing aortic pathologies. We present the case of an elderly woman with breast carcinoma treated for 18 years with antiestrogen therapy who subsequently developed acute thoracic aortic deterioration (enlargement and wall disruption).
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Affiliation(s)
- Rishi Tripathi
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Sandeep Sainathan
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
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Razi SS, John MM, Sainathan S, Stavropoulos C. Sublobar resection is equivalent to lobectomy for T1a non-small cell lung cancer in the elderly: a Surveillance, Epidemiology, and End Results database analysis. J Surg Res 2015; 200:683-9. [PMID: 26490227 DOI: 10.1016/j.jss.2015.08.045] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 05/12/2015] [Revised: 07/23/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anatomic lobectomy with mediastinal lymph node dissection is considered the optimal management for early stage non-small cell lung cancer (NSCLC). Limited lung resection may be preferable in the elderly population, who are more likely to have poor pulmonary reserve and multiple comorbidities. Our primary objective was to compare the survival of patients aged ≥ 75 y who underwent sublobar resection or lobectomy for stage IA NSCLC. MATERIALS AND METHODS We queried the Surveillance, Epidemiology, and End Results database for patients aged ≥ 75 y who were diagnosed with stage IA NSCLC from 1998-2007. Patients were divided into three groups based on the type of surgery performed (wedge resection, segmentectomy, and lobectomy). Kaplan-Meier analysis and Cox proportional hazard model were used for survival analysis. RESULTS A total of 1640 patients were analyzed. Lobectomy was performed in 1051 patients, 119 underwent segmentectomy, and 470 patients had wedge resection. Overall and cancer-specific survival were significantly lower in the wedge resection group as compared with those in lobectomy (P < 0.05). However, for T1a tumors, no significant difference was found in risk adjusted 5-y cancer-specific survival for patients who underwent wedge resection, segmentectomy (hazard ratio, 1.009; 95% confidence interval 0.624-1.631; P = 0.972), or lobectomy (hazard ratio, 0.98; 95% confidence interval, 0.691-1.388; P = 0.908). CONCLUSIONS Sublobar resection is not inferior to lobectomy for T1a N0 M0 NSCLC in the elderly and should be considered a viable alternative in this high-risk population.
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Affiliation(s)
- Syed S Razi
- Division of Thoracic Surgery, Department of Surgery, Bronx-Lebanon Hospital Center, New York, New York.
| | - Mohan M John
- Division of Thoracic Surgery, Department of Surgery, Bronx-Lebanon Hospital Center, New York, New York
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christos Stavropoulos
- Division of Thoracic Surgery, Department of Surgery, Bronx-Lebanon Hospital Center, New York, New York; Division of Thoracic Surgery, Department of Surgery, Lenox-Hill Hospital, New York, New York
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Zahr RA, Kirshbom P, Kopf G, Sainathan S, Steele MM, Elder R, Karimi M. HALF A CENTURY’S EXPERIENCE WITH CLASSIC GLENN SHUNT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sainathan S. eComment. Optimal management of chylothorax following oesophagectomy. Interact Cardiovasc Thorac Surg 2014; 19:119-20. [PMID: 24944322 DOI: 10.1093/icvts/ivu133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sainathan S, Wu LD, Andaz S. Delayed esophageal perforation from stereotactic body radiation therapy for locally recurrent central nonsmall cell lung cancer. Lung India 2014; 31:158-60. [PMID: 24778482 PMCID: PMC3999679 DOI: 10.4103/0970-2113.129854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) is a novel form of external beam radiation therapy. It is used to treat early and locally recurrent nonsmall cell lung cancer (NSLC) in medically inoperable patients. It uses high dose, hypofractionated radiotherapy, with targeting of the tumor by precise spatial localization, thus minimizing injury to surrounding tissues. It can be safely used to ablate NSLC in both central and peripheral locations. We present two cases of delayed esophageal perforation after SBRT for locally recurrent central NSLC. The perforations occurred several months after the therapy. They were treated with covered esophageal stents, with mortality, due to the perforation in one of the patients. SBRT should be judiciously used to ablate centrally located NSLC and patients who develop episodes of esophagitis during or after SBRT, need to be closely followed with endoscopy to look for esophageal ulcerations. These ulcers should be closely followed for healing as these may degenerate into full thickness perforations several months after SBRT.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York 10457, USA
| | - Leester D Wu
- Department of Radiation Oncology, South Nassau Communities Hospital, Oceanside, New York 11572, USA
| | - Shahriyour Andaz
- Department of Thoracic Surgery, South Nassau Communities Hospital, Oceanside, New York 11572, USA
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Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was, 'in adult patients who require a tube thoracostomy, is the trocar technique comparable to blunt dissection in terms of rate of tube malposition or complications?' Altogether more than 258 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The articles included two retrospective reviews, three prospective observational studies and two prospective randomized studies. Of these, four papers concluded that the trocar technique was associated with a significantly higher rate of tube malposition and complications. One retrospective review found that the rate of tube malposition was similar in both groups; however, the trocar technique was abandoned due to the occurrence of severe complications like lung and stomach injury. Another study found that blunt dissection into the pleural space followed by the use of a trocar to direct the chest tube was as safe as and even more effective than blunt dissection alone. A randomized prospective study in cadavers comparing blunt vs sharp tip trocars reported that the use of blunt tip trocars resulted in less complications. We conclude that the trocar technique for chest tube placement should be avoided in adult patients as it is associated with a higher incidence of malposition and complications. The blunt dissection technique with digital exploration of the pleural cavity prior to chest tube placement is the safest technique and should be considered standard practice.
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Affiliation(s)
- Mohan John
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - Syed Razi
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, Yale-New Haven Hospital, New Haven, CT, USA
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Fan P, Sainathan S, Andaz S. Continuing Medical Education Activity in Echocardiography. Echocardiography 2013. [DOI: 10.1111/echo.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Sandeep Sainathan
- Department of Thoracic Surgery; Bronx-Lebanon Hospital Center; Bronx; New York
| | - Shahriyour Andaz
- Department of Thoracic Surgery; South Nassau Communities Hospital; Oceanside; New York
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Sainathan S. eComment. Balancing the pulmonary circulation in tricuspid atresia with an aortopulmonary window. Interact Cardiovasc Thorac Surg 2013; 17:443. [PMID: 23868968 DOI: 10.1093/icvts/ivt247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sandeep Sainathan
- Albert Einstein College of Medicine/Bronx-Lebanon Hospital, New York, NY, USA
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Affiliation(s)
- Sandeep Sainathan
- Department of Thoracic Surgery; Bronx-Lebanon Hospital Center; Bronx; New York
| | - Shahriyour Andaz
- Department of Thoracic Surgery; South Nassau Communities Hospital; Oceanside; New York
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Sainathan S, Andaz S. Unusual cause of an esophageal perforation in a nonagenarian. J Am Geriatr Soc 2013; 61:838-9. [PMID: 23672557 DOI: 10.1111/jgs.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York 10457, USA.
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Sainathan S. Integrated Thoracic Residency: The Only Pathway of Thoracic Surgery Training in the Future? Ann Thorac Surg 2012; 94:1374. [DOI: 10.1016/j.athoracsur.2012.02.088] [Citation(s) in RCA: 4] [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] [Received: 11/28/2011] [Revised: 01/10/2012] [Accepted: 02/24/2012] [Indexed: 10/27/2022]
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Sainathan S, Andaz S. A case of pacemaker related superior venacaval syndrome after thoracic surgery. Pacing Clin Electrophysiol 2012; 36:505-7. [PMID: 22978253 DOI: 10.1111/j.1540-8159.2012.03520.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/06/2012] [Accepted: 05/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA.
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Sainathan S, Andaz S. Porous diaphragm syndrome. Eur J Cardiothorac Surg 2012; 43:200. [PMID: 22764149 DOI: 10.1093/ejcts/ezs399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY, USA.
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Sainathan S, Pugalenthi A, Danovich S, Arif F, Andaz S. Epithelial-myoepithelial carcinoma of the lung. Am Surg 2012; 78:E290-E291. [PMID: 22546111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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Affiliation(s)
| | | | - Svetlana Danovich
- Department of Surgery South Nassau Communities Hospital Oceanside, New York
| | - Farzana Arif
- Department of Pathology South Nassau Communities Hospital Oceanside, New York
| | - Shahriyour Andaz
- Department of Surgery South Nassau Communities Hospital Oceanside, New York
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Sainathan S, Pugalenthi A, Danovich S, Arif F, Andaz S. Epithelial-myoepithelial carcinoma of the lung. Am Surg 2012; 78:E290-E291. [PMID: 22691334] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA.
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