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Carroll AM, Chanes N, Shah A, Dzubinski L, Aftab M, Reece TB. Personalizing Patient Risk of a Life Altering Event: An Application of Machine Learning to Hemiarch Surgery. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00366-0. [PMID: 38685466 DOI: 10.1016/j.jtcvs.2024.04.022] [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: 02/05/2024] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To assess a machine learning model's ability to predict the occurrence of life altering events (LAE) in hemiarch surgery and determine contributing patient characteristics and intraoperative factors. METHODS In total, 602 patients who underwent hemiarch replacement at a high-volume, aortic center from 2009-2022 were included. Patients were randomly divided into training (80%) and testing (20%) sets with various eXtreme gradient boosting (XGBoost) candidate models constructed to predict the risk of experiencing LAE, including stroke, mortality, or new renal replacement therapy requirement. 64 input parameters from the index hospitalization were identified, including 24 demographic characteristics as well as 8 pre-operative and 32 intra-operative variables. A SHapley Additive exPlanation (SHAP) beeswarm plot was generated to identify and interpret the impact of individual features on the predictions of the final model. RESULTS A LAE was noted in 15% (90/602) of patients who underwent hemiarch replacement, including urgent/emergent cases and dissections. The final XGBoost model demonstrated a cross-validation accuracy of 88% on the testing set and was well-calibrated as evidenced by a low Brier score of 0.12. The best performing model achieved an area under the receiver-operating characteristic curve of 0.76 and an area under the precision-recall curve of 0.55. The SHAP beeswarm plot provided insights into key features that significantly influenced model prediction. CONCLUSIONS Machine learning demonstrated superior accuracy in predicting hemiarch patients that would experience a LAE. This model may help to guide patients and clinicians in stratifying risk on an individual basis, which may in turn influence clinical decision-making.
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Affiliation(s)
- Adam M Carroll
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO.
| | - Nicolas Chanes
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - Ananya Shah
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - Lance Dzubinski
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
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Rove JY, Cain MT, Hoffman JR, Reece TB. Noteworthy in Cardiothoracic Surgery 2023. Semin Cardiothorac Vasc Anesth 2024:10892532241246037. [PMID: 38631341 DOI: 10.1177/10892532241246037] [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: 04/19/2024]
Abstract
Noteworthy in Cardiothoracic Surgery 2023 summarizes a few of the most high-impact trials and provocative trends in cardiothoracic surgery and transplantation this past year. Transplantation using organs procured from donation after circulatory death (DCD) continues to increase, and the American Society of Transplant Surgeons released recommendations on best practices in 2023. We review a summary of data on the impact of DCD on heart and lung transplantation. There has been increased interest in extracorporeal life support (ECLS), particularly after the COVID-19 pandemic, and we review the results of the highly discussed ECLS-SHOCK trial, which randomized patients in cardiogenic shock with planned revascularization to ECLS vs usual care. With improving survival outcomes in complex aortic surgery, there is a need for higher-quality evidence to guide which cooling and cerebral perfusion strategies may optimize cognitive outcomes in these patients. We review the short-term outcomes of the GOT ICE trial (Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest), a multicenter, randomized controlled trial of three different nadir temperatures, evaluating outcomes in cognition and associated changes in functional magnetic resonance imaging. Finally, both the Society of Thoracic Surgeons (STS) and the American College of Cardiology, American Heart Association, American College of Chest Physicians and Heart Rhythm Society (ACC/AHA/ACCP/HRS) updated atrial fibrillation guidelines in 2023, and we review surgically relevant updates to the guidelines and the evidence behind them.
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Affiliation(s)
- Jessica Y Rove
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael T Cain
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jordan R Hoffman
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Brett Reece
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Bakhtiyar SS, Maksimuk TE, Gutowski J, Park SY, Cain MT, Rove JY, Reece TB, Cleveland JC, Pomposelli JJ, Bababekov YJ, Nydam TL, Schold JD, Pomfret EA, Hoffman JRH. Association of procurement technique with organ yield and cost following donation after circulatory death. Am J Transplant 2024:S1600-6135(24)00237-5. [PMID: 38521350 DOI: 10.1016/j.ajt.2024.03.027] [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: 01/13/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution's experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative.
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Affiliation(s)
- Syed Shahyan Bakhtiyar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA.
| | - Tiffany E Maksimuk
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - John Gutowski
- University of Colorado Hospital Transplant Center, Aurora, Colorado, USA
| | - Sarah Y Park
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael T Cain
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA
| | - James J Pomposelli
- University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Yanik J Bababekov
- University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Trevor L Nydam
- University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Jesse D Schold
- Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Elizabeth A Pomfret
- University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Jordan R H Hoffman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA
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Suarez-Pierre A, Iguidbashian J, Kirsch MJ, Cain MT, Aftab M, Reece TB, Fullerton DA, Rove JY, Cleveland JC, Hoffman JRH. Association of cardiac preservation solution with short-term outcomes after heart transplantation. J Cardiovasc Med (Hagerstown) 2024; 25:158-164. [PMID: 38149702 DOI: 10.2459/jcm.0000000000001575] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
AIMS There is wide variability in the practice of cardiac preservation for heart transplantation. Prior reports suggest that the type of solution may be linked with a reduced incidence of posttransplantation complications. METHODS Adult (≥18 years old) heart recipients who underwent transplantation between 2015 and 2021 in the United States were examined. Recipients were stratified by solution utilized for their grafts at the time of recovery: University of Wisconsin, histidine-tryptophan-ketoglutarate (HTK), or Celsior solution. The primary endpoint was a composite of 30-day mortality, primary graft dysfunction, or re-transplantation. Risk adjustment was performed for the recipient, donor, and procedural characteristics using regression modeling. RESULTS Among 16 884 recipients, the group distribution was University of Wisconsin solution 53%, HTK 22%, Celsior solution 15%, and other 10%. The observed incidence of the composite endpoint (University of Wisconsin solution = 3.6%, HTK = 4.0%, Celsior solution = 3.7%, P = 0.301) and 1-year survival (University of Wisconsin solution = 91.7%, HTK = 91.3%, Celsior solution = 91.7%, log-rank P = 0.777) were similar between groups. After adjustment, HTK was associated with a higher risk of the composite endpoint [odds ratio (OR) 1.249, 95% confidence interval (CI) 1.019-1.525, P = 0.030] in reference to University of Wisconsin solution. This association was substantially increased among recipients with ischemic periods of greater than 4 h (OR 1.817, 95% CI 1.188-2.730, P = 0.005). The risks were similar between University of Wisconsin solution and Celsior solution (P = 0.454). CONCLUSION The use of the histidine-tryptophan-ketoglutarate solution during cold static storage for cardiac preservation is associated with increased rates of early mortality or primary graft dysfunction. Clinician discretion should guide its use, especially when prolonged ischemic times (>4 h) are anticipated.
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Affiliation(s)
- Alejandro Suarez-Pierre
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
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Suarez-Pierre A, Zakrzewski J, Anigbogu C, Iguidbashian JP, Ziogas IA, Peters LL, Ambardekar AV, Hoffman JR, Reece TB, Cleveland JC, Rove JY. Prolonged travel time to transplantation center is associated with poor outcomes following heart transplantation. Am J Surg 2024; 228:279-286. [PMID: 38030453 DOI: 10.1016/j.amjsurg.2023.10.052] [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: 07/17/2023] [Revised: 10/08/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND This study aims to examine the impact of home-to-transplantation center travel time as a potential barrier to healthcare accessibility. METHODS Observational study examined adult heart transplant recipients who received a graft between 2012 and 2022 in the United States. Travel time was calculated using the Google Distance Matrix API between the recipient's residence and transplantation center. A multivariable parametric survival model was fitted to minimize confounding bias. RESULTS Among the 25,923 recipients that met the selection criteria, the median travel time was 51 min and 95 % of recipients lived within a 5-h radius of their center. White recipients experienced longer median travel times (62 min, p < 0.001) compared to Black (36 min) or Hispanic (40 min) recipients. A travel time of 1-2 h (survival time ratio [STR] 0.867, p = 0.035) or >2 h (STR 0.873, p = 0.026) away from the transplantation center was independently associated with lower long-term survival rates. CONCLUSION Extended travel times to transplantation centers may negatively impact long-term survival outcomes for heart transplant recipients, suggesting the need to address this potential barrier to healthcare accessibility.
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Affiliation(s)
- Alejandro Suarez-Pierre
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jack Zakrzewski
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chiagoziem Anigbogu
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - John P Iguidbashian
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ioannis A Ziogas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura L Peters
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jordan Rh Hoffman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Rossi PJ, Desai ND, Malaisrie SC, Lyden SP, Nassiri N, Reece TB, Adams JD, Moanie SL, Shults CC. One-Year Results of a Low-Profile Endograft in Acute, Complicated Type B Aortic Dissection. Ann Thorac Surg 2024; 117:336-343. [PMID: 37769702 DOI: 10.1016/j.athoracsur.2023.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/02/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The safety and effectiveness of the RelayPro endograft (Terumo Aortic) was assessed for the treatment of acute, complicated type B aortic dissection (TBAD). METHODS A prospective pivotal trial analyzed a primary end point of all-cause mortality at 30 days. Secondary end points included technical success, major adverse events (disabling stroke, renal failure, and paraplegia/paralysis), endoleaks, patency, rupture, device integrity, false lumen perfusion, reinterventions, aortic expansion, and migration evaluated to 5 years. RESULTS The study involved 22 United States centers and enrolled 56 patients (mean age, 59.5 ± 11.4 years) from 2017 to 2021; of whom, 73.2% were men and 53.6% were African American. TBAD was complicated by malperfusion of the kidneys (51.8%), lower extremities (35.7%), and viscera (33.9%), and rupture (10.7%). Dissection extended proximally to zones 1/2 (14.3%) and zone 3 (78.6%) and distally to the iliac arteries (67.3%). Most procedures were percutaneous (85.5%). Technical success was 100%. Median hospitalization was 7 days (interquartile range, 5-12 days). All-cause mortality at 30 days was 1.8% (1 of 56; upper 95% CI, 8.2%; P < .0001). Seven major adverse events occurred in 6 patients (10.7%), consisting of paraplegia (n = 3), paraparesis (n = 2), disabling stroke (n = 1), and renal failure (n = 1). All paraplegia/paraparesis resolved with lumbar drainage. Kaplan-Meier analysis estimated a freedom from major adverse events of 89.1% at each interval from 30 days to 3 years. There was 1 endoleak (Type Ia), 2 retrograde dissections, and aortic diameter growth occurred in 2. There has been no rupture, fistula, component separation, patency loss, stenosis, kinking, twisting, bird beak, loss of device integrity, or fracture. CONCLUSIONS RelayPro is safe and effective in acute, complicated TBAD. Follow-up is ongoing to evaluate longer-term outcomes and durability.
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Affiliation(s)
- Peter J Rossi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Chris Malaisrie
- Department of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Sean P Lyden
- Department of Vascular Surgery and Aortic Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Joshua D Adams
- Carilion Clinic Aortic Center, Virginia Tech Carilion School of Medicine, Temple University School of Medicine, Roanoke, Virginia
| | - Sina L Moanie
- Department of Cardiothoracic Surgery, St. Vincent Heart Center of Indiana, Indianapolis, Indiana
| | - Christian C Shults
- Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
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Snyder EL, Sekela ME, Welsby IJ, Toyoda Y, Alsammak M, Sodha NR, Beaver TM, Pelletier JPR, Gorham JD, McNeil JS, Sniecinski RM, Pearl RG, Nuttall GA, Sarode R, Reece TB, Kaplan A, Davenport RD, Ipe TS, Benharash P, Lopez-Plaza I, Gammon RR, Sadler P, Pitman JP, Liu K, Bentow S, Corash L, Mufti N, Varrone J, Benjamin RJ. Evaluation of the efficacy and safety of amustaline/glutathione pathogen-reduced RBCs in complex cardiac surgery: the Red Cell Pathogen Inactivation (ReCePI) study-protocol for a phase 3, randomized, controlled trial. Trials 2023; 24:799. [PMID: 38082326 PMCID: PMC10712151 DOI: 10.1186/s13063-023-07831-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Red blood cell (RBC) transfusion is a critical supportive therapy in cardiovascular surgery (CVS). Donor selection and testing have reduced the risk of transfusion-transmitted infections; however, risks remain from bacteria, emerging viruses, pathogens for which testing is not performed and from residual donor leukocytes. Amustaline (S-303)/glutathione (GSH) treatment pathogen reduction technology is designed to inactivate a broad spectrum of infectious agents and leukocytes in RBC concentrates. The ReCePI study is a Phase 3 clinical trial designed to evaluate the efficacy and safety of pathogen-reduced RBCs transfused for acute anemia in CVS compared to conventional RBCs, and to assess the clinical significance of treatment-emergent RBC antibodies. METHODS ReCePI is a prospective, multicenter, randomized, double-blinded, active-controlled, parallel-design, non-inferiority study. Eligible subjects will be randomized up to 7 days before surgery to receive either leukoreduced Test (pathogen reduced) or Control (conventional) RBCs from surgery up to day 7 post-surgery. The primary efficacy endpoint is the proportion of patients transfused with at least one study transfusion with an acute kidney injury (AKI) diagnosis defined as any increased serum creatinine (sCr) level ≥ 0.3 mg/dL (or 26.5 µmol/L) from pre-surgery baseline within 48 ± 4 h of the end of surgery. The primary safety endpoints are the proportion of patients with any treatment-emergent adverse events (TEAEs) related to study RBC transfusion through 28 days, and the proportion of patients with treatment-emergent antibodies with confirmed specificity to pathogen-reduced RBCs through 75 days after the last study transfusion. With ≥ 292 evaluable, transfused patients (> 146 per arm), the study has 80% power to demonstrate non-inferiority, defined as a Test group AKI incidence increase of no more than 50% of the Control group rate, assuming a Control incidence of 30%. DISCUSSION RBCs are transfused to prevent tissue hypoxia caused by surgery-induced bleeding and anemia. AKI is a sensitive indicator of renal hypoxia and a novel endpoint for assessing RBC efficacy. The ReCePI study is intended to demonstrate the non-inferiority of pathogen-reduced RBCs to conventional RBCs in the support of renal tissue oxygenation due to acute anemia and to characterize the incidence of treatment-related antibodies to RBCs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - James D Gorham
- University of Virginia Health System, Charlottesville, VA, USA
| | - John S McNeil
- University of Virginia Health System, Charlottesville, VA, USA
| | | | | | | | - Ravi Sarode
- University of Texas, Southwestern, Dallas, TX, USA
| | | | - Alesia Kaplan
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Vitalant, Pittsburgh, PA, USA
| | | | - Tina S Ipe
- Our Blood Institute, Oklahoma City, OK, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Richard R Gammon
- Scientific, Medical and Technical and Research Department, OneBlood, Orlando, FL, USA
| | | | - John P Pitman
- Cerus Corporation, 1220 Concord Ave, Concord, CA, 94520, USA
| | - Kathy Liu
- Cerus Corporation, 1220 Concord Ave, Concord, CA, 94520, USA
| | - Stanley Bentow
- Cerus Corporation, 1220 Concord Ave, Concord, CA, 94520, USA
| | - Laurence Corash
- Cerus Corporation, 1220 Concord Ave, Concord, CA, 94520, USA
| | - Nina Mufti
- Cerus Corporation, 1220 Concord Ave, Concord, CA, 94520, USA
| | - Jeanne Varrone
- Cerus Corporation, 1220 Concord Ave, Concord, CA, 94520, USA
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8
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Halpern Mungo A, Reece TB, Taylor LJ. Mentorship Matters. Ann Thorac Surg 2023; 116:1335-1336. [PMID: 36787841 DOI: 10.1016/j.athoracsur.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Alison Halpern Mungo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Hospital, 12605 E 16th Ave, Aurora, CO 80045
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Hospital, 12605 E 16th Ave, Aurora, CO 80045
| | - Lauren J Taylor
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Hospital, 12605 E 16th Ave, Aurora, CO 80045.
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Cain MT, Park SY, Schäfer M, Hay-Arthur E, Justison GA, Zhan QP, Campbell D, Mitchell JD, Randhawa SK, Meguid RA, David EA, Reece TB, Cleveland JC, Hoffman JR. Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experience. JTCVS Tech 2023; 22:350-358. [PMID: 38152164 PMCID: PMC10750961 DOI: 10.1016/j.xjtc.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 09/21/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Donation after circulatory death (DCD) procurement and transplantation after thoracoabdominal normothermic regional perfusion (TA-NRP) remains a novel technique to improve cardiac and hepatic allograft preservation but may be complicated by lung allograft pulmonary edema. We present a single-center series on early implementation of a lung-protective protocol with strategies to mitigate posttransplant pulmonary edema in DCD lung allografts after TA-NRP procurement. Methods Data from all lung transplantations performed using a TA-NRP procurement strategy from October 2022 to April 2023 are presented. Donor management consisted of key factors to reduce lung allograft pulmonary edema: aggressive predonation and early posttransplant diuresis, complete venous drainage at TA-NRP initiation, and early pulmonary artery venting upon initiation of systemic perfusion. Donor and recipient characteristics, procurement characteristics such as TA-NRP intervals, and 30-day postoperative outcomes were assessed. Results During the study period, 8 lung transplants were performed utilizing TA-NRP procurement from DCD donors. Donor ages ranged from 16 to 39 years and extubation time to declaration of death ranged from 10 to 90 minutes. Time from declaration to TA-NRP initiation was 7 to 17 minutes with TA-NRP perfusion times of 49 to 111 minutes. Median left and right allograft warm ischemia times were 55.5 minutes (interquartile range, 46.5-67.5 minutes) and 41.0 minutes (interquartile range, 39.0-53.0 minutes, respectively, with 2 recipients supported with cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during implantation. No postoperative extracorporeal membrane oxygenation was required. There were no pulmonary-related deaths; however, 1 patient died from complications of severe necrotizing pancreatitis with a normal functioning allograft. All patients were extubated within 24 hours. Index intensive care unit length of stay ranged from 3 to 11 days with a hospital length of stay of 13 to 37 days. Conclusions Despite concern regarding quality of DCD lung allografts recovered using the TA-NRP technique, we report initial success using this procurement method. Implementation of strategies to mitigate pulmonary edema can result in acceptable outcomes following lung transplantation. Demonstration of short- and long-term safety and efficacy of this technique will become increasingly important as the use of TA-NRP for thoracic and abdominal allografts in DCD donors expands.
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Affiliation(s)
- Michael T. Cain
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Sarah Y. Park
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Michal Schäfer
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Emily Hay-Arthur
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - George A. Justison
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Qui Peng Zhan
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - David Campbell
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - John D. Mitchell
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Simran K. Randhawa
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Robert A. Meguid
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Elizabeth A. David
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - T. Brett Reece
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Joseph C. Cleveland
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
| | - Jordan R.H. Hoffman
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colo
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Carroll AM, King RW, Ghincea CV, Aftab M, Reece TB. Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside. Ann Cardiothorac Surg 2023; 12:438-449. [PMID: 37817853 PMCID: PMC10561340 DOI: 10.21037/acs-2023-scp-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 10/12/2023]
Abstract
This keynote lecture and corresponding presentation discuss the anatomy and pathophysiology surrounding spinal cord injury in aortic surgery. This article will discuss risk factors and mechanisms for spinal cord injury, including loss of direct and collateral spinal cord perfusion and ischemia-reperfusion injury. This review will examine these elements in both the laboratory and clinical setting, in addition to other neuroprotective strategies applied in clinical practice. Addressing spinal cord injury requires an integrated and considerate approach to simultaneously optimize spinal cord blood flow, promote collateralization and improve ischemic tolerance. Given the catastrophic clinical consequences for both the patient and their caregivers, continuing to investigate and examine spinal cord injury is of the utmost importance.
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Affiliation(s)
- Adam M Carroll
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA
| | - R Wilson King
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christian V Ghincea
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA
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11
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Suarez-Pierre A, Iguidbashian J, Vigneshwar N, Breithaupt J, Fullerton DA, Reece TB, Hoffman JRH, Cleveland JC, Rove JY. Variability in Heart Yield From Donation After Brain Death Between Organ Procurement Organizations: An Opportunity for Improvement. ASAIO J 2023; 69:e322-e332. [PMID: 37382896 DOI: 10.1097/mat.0000000000001973] [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] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Increasing the number of available hearts for transplantation is the best strategy to decrease waitlist mortality. This study examines organ procurement organizations (OPOs) and their role in the transplantation network to determine whether variability in performance exists across them. Adult deceased donors who met the criteria for brain death between 2010 and 2020 (inclusive) in the United States were examined. A regression model was fitted and internally validated using donor characteristics available at the time of organ recovery to predict the likelihood of heart transplantation. Subsequently, an expected heart yield was calculated for each donor using this model. Observed-to-expected (O/E) heart yield ratios for each OPO were calculated by dividing the number of hearts recovered for transplantation by the expected number of recoveries. There were 58 OPOs active during the study period, and on average, OPO activity grew over time. The mean O/E ratio among OPOs was 0.98 (standard deviation ± 0.18). Twenty-one OPOs consistently performed below the expected level (95% confidence intervals < 1.0) and generated a deficit of 1,088 expected transplantations during the study period. The proportion of hearts that were recovered for transplantation varied significantly by OPO categories: low tier 31.8%, mid tier 35.6%, and high tier 36.2% (p < 0.01), even as the expected yield was similar across tiers (p = 0.69). OPO performance accounts for 28% of the variability in successfully transplanting a heart after accounting for the role of referring hospitals, donor families, and transplantation centers. In conclusion, there is significant variability in volume and heart yield from brain-dead donors across OPOs.
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Affiliation(s)
- Alejandro Suarez-Pierre
- From the Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Schäfer M, Carroll A, Carmody KK, Hunter KS, Barker AJ, Aftab M, Reece TB. Aortic shape variation after frozen elephant trunk procedure predicts aortic events: Principal component analysis study. JTCVS Open 2023; 14:26-35. [PMID: 37425456 PMCID: PMC10328758 DOI: 10.1016/j.xjon.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/26/2023] [Indexed: 07/11/2023]
Abstract
Objective The frozen elephant trunk procedure is a well-established technique for the repair of type A ascending aortic dissection and complex aortic arch pathology. The ultimate shape created by the repair may have consequences in long-term complications. The purpose of this study was to apply a machine learning technique to comprehensively describe 3-dimensional aortic shape variations after the frozen elephant trunk procedure and associate these variations with aortic events. Methods Computed tomography angiography acquired before discharge of patients (n = 93) who underwent the frozen elephant trunk procedure for type A ascending aortic dissection or ascending aortic arch aneurysm was preprocessed to yield patient-specific aortic models and centerlines. Aortic centerlines were subjected to principal component analysis to describe principal components and aortic shape modulators. Patient-specific shape scores were correlated with outcomes defined by composite aortic event, including aortic rupture, aortic root dissection or pseudoaneurysm, new type B dissection, new thoracic or thoracoabdominal pathologies, residual descending aortic dissection with residual false lumen flow, or thoracic endovascular aortic repair complications. Results The first 3 principal components accounted for 36.4%, 26.4%, and 11.6% of aortic shape variance, respectively, and cumulatively for 74.5% of the total shape variation in all patients. The first principal component described variation in arch height-to-length ratio, the second principal component described angle at the isthmus, and the third principal component described variation in anterior-to-posterior arch tilt. Twenty-one aortic events (22.6%) were encountered. The degree of aortic angle at the isthmus described by the second principal component was associated with aortic events in logistic regression (hazard ratio, 0.98; 95% confidence interval, 0.97-0.99; P = .046). Conclusions The second principal component, describing angulation at the region of the aortic isthmus, was associated with adverse aortic events. Observed shape variation should be evaluated in the context of aortic biomechanical properties and flow hemodynamics.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
| | - Adam Carroll
- Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
| | - Kody K. Carmody
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
| | - Kendall S. Hunter
- Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
| | - Alex J. Barker
- Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
| | - T. Brett Reece
- Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Denver, Colo
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13
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Mumtaz M, Thompson RB, Moon MR, Sultan I, Reece TB, Keeling WB, DeLaRosa J. Safety and efficacy of a kaolin-impregnated hemostatic gauze in cardiac surgery: A randomized trial. JTCVS Open 2023; 14:134-144. [PMID: 37425449 PMCID: PMC10328980 DOI: 10.1016/j.xjon.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 07/11/2023]
Abstract
Objective A kaolin-based nonresorbable hemostatic gauze, QuikClot Control+, has demonstrated effective hemostasis and safety when used for severe/life-threatening (grade 3/4) internal organ space bleeding. We evaluated the efficacy and safety of this gauze for mild to moderate (grade 1-2) bleeding in cardiac surgery compared with control gauze. Methods This was a randomized, controlled, single-blinded study of patients who underwent cardiac surgery between June 2020 and September 2021 across 7 sites with 231 subjects randomized 2:1 to QuikClot Control+ or control. The primary efficacy end point was hemostasis rate (ie, subjects achieving grade 0 bleed) through up to 10 minutes of bleeding site application, assessed using a semiquantitative validated bleeding severity scale tool. The secondary efficacy end point was the proportion of subjects achieving hemostasis at 5 and 10 minutes. Adverse events, assessed up to 30 days postsurgery, were compared between arms. Results The predominant procedure was coronary artery bypass grafting, and 69.7% and 29.4% were sternal edge and surgical site (suture line)/other bleeds, respectively. Of the QuikClot Control+ subjects, 121 of 153 (79.1%) achieved hemostasis within 5 minutes, compared with 45 of 78 (58.4%) controls (P < .001). At 10 minutes, 137 of 153 patients (89.8%) achieved hemostasis compared with 52 of 78 controls (68.4%) (P < .001). At 5 and 10 minutes, hemostasis was achieved in 20.7% and 21.4% more QuikClot Control+ subjects, respectively, compared with controls (P < .001). There were no significant differences in safety or adverse events between treatment arms. Conclusions QuikClot Control+ demonstrated superior performance in achieving hemostasis for mild to moderate cardiac surgery bleeding compared with control gauze. The proportion of subjects achieving hemostasis was more than 20% higher in QuikClot Control+ subjects at both timepoints compared with controls, with no significant difference in safety outcomes.
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Affiliation(s)
| | | | - Marc R. Moon
- Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex
| | | | - T. Brett Reece
- Cardiothoracic Surgery, University of Colorado Health, Aurora, Colo
| | - William B. Keeling
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Jacob DeLaRosa
- Cardiac Surgery, Portneuf Medical Center, Pocatello, Idaho
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14
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Carroll AM, Lin Y, Reece TB. Triple-Branched Stent Graft for Acute Non-A, Non-B Dissection: An Interesting Step, But Is It Forward? Ann Thorac Surg 2023; 115:589-590. [PMID: 35051390 DOI: 10.1016/j.athoracsur.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Adam M Carroll
- Division of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Rm 6602, MS C310, PO Box 6511, Aurora, CO 80045
| | - Yihan Lin
- Division of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Rm 6602, MS C310, PO Box 6511, Aurora, CO 80045
| | - T Brett Reece
- Division of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Rm 6602, MS C310, PO Box 6511, Aurora, CO 80045.
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15
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Ikeno Y, Ghincea CV, Roda GF, Cheng L, Aftab M, Meng X, Weyant MJ, Cleveland JC, Fullerton DA, Reece TB. Direct and indirect activation of the adenosine triphosphate-sensitive potassium channel to induce spinal cord ischemic metabolic tolerance. J Thorac Cardiovasc Surg 2023; 165:e90-e99. [PMID: 34763893 DOI: 10.1016/j.jtcvs.2021.08.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The mitochondrial adenosine triphosphate-sensitive potassium channel is central to pharmacologically induced tolerance to spinal cord injury. We hypothesized that both direct and nitric oxide-dependent indirect activation of the adenosine triphosphate-sensitive potassium channel contribute to the induction of ischemic metabolic tolerance. METHODS Spinal cord injury was induced in adult male C57BL/6 mice through 7 minutes of thoracic aortic crossclamping. Pretreatment consisted of intraperitoneal injection 3 consecutive days before injury. Experimental groups were sham (no pretreatment or ischemia, n = 10), spinal cord injury control (pretreatment with normal saline, n = 27), Nicorandil 1.0 mg/kg (direct and indirect adenosine triphosphate-sensitive potassium channel opener, n = 20), Nicorandil 1 mg/kg + carboxy-PTIO 1 mg/kg (nitric oxide scavenger, n = 21), carboxy-PTIO (n = 12), diazoxide 5 mg/kg (selective direct adenosine triphosphate-sensitive potassium channel opener, n = 25), and DZ 5 mg/kg+ carboxy-PTIO 1 mg/kg, carboxy-PTIO (n = 23). Limb motor function was assessed using the Basso Mouse Score (0-9) at 12-hour intervals for 48 hours after ischemia. RESULTS Motor function was significantly preserved at all time points after ischemia in the Nicorandil pretreatment group compared with ischemic control. The addition of carboxy-PTIO partially attenuated Nicorandil's motor-preserving effect. Motor function in the Nicorandil + carboxy-PTIO group was significantly preserved compared with the spinal cord injury control group (P < .001), but worse than in the Nicorandil group (P = .078). Motor preservation in the diazoxide group was similar to the Nicorandil + carboxy-PTIO group. There was no significant difference between the diazoxide and diazoxide + carboxy-PTIO groups. CONCLUSIONS Both direct and nitric oxide-dependent indirect activation of the mitochondrial adenosine triphosphate-sensitive potassium channel play an important role in pharmacologically induced motor function preservation.
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Affiliation(s)
- Yuki Ikeno
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Christian V Ghincea
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Gavriel F Roda
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Linling Cheng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Xianzhong Meng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Michael J Weyant
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo.
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Wojcik BM, Reece TB. Commentary: Size matters, but not as much as surgeon preference. J Thorac Cardiovasc Surg 2023; 165:28-29. [PMID: 33712242 DOI: 10.1016/j.jtcvs.2021.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Brandon M Wojcik
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo.
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Eldeiry M, Miyamoto S, Chatfield K, Reece TB, Mitchell MB. Frozen elephant trunk aortic reconstruction in a patient with Loeys-Dietz syndrome. JTCVS Tech 2022; 16:8-10. [PMID: 36510543 PMCID: PMC9735389 DOI: 10.1016/j.xjtc.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/13/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Mohamed Eldeiry
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo,Address for reprints: Mohamed Eldeiry, MD, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver, 126 31 E 17th Ave, C291, Room 5401, Aurora, CO 80045.
| | - Shelley Miyamoto
- Department of Cardiovascular Surgery, Children's Hospital Colorado, Aurora, Colo
| | - Kathryn Chatfield
- Department of Cardiovascular Surgery, Children's Hospital Colorado, Aurora, Colo
| | - T. Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Max B. Mitchell
- Department of Cardiovascular Surgery, Children's Hospital Colorado, Aurora, Colo
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Bhamidipati CM, Randhawa S, Reece TB, Nguyen TC, Shen I, Pal JD, Rove JY. How to transition to the “left side of the table”—becoming a master surgical educator. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00944-8. [DOI: 10.1016/j.jtcvs.2022.09.007] [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] [Received: 07/14/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
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Gerdisch MW, Reece TB, Emerson D, Downey RS, Blossom GB, Singhal A, Baker JN, Fischlein TJ, Badhwar V. Early results of geometric ring annuloplasty for bicuspid aortic valve repair during aortic aneurysm surgery. JTCVS Tech 2022; 14:55-65. [PMID: 35967205 PMCID: PMC9367630 DOI: 10.1016/j.xjtc.2022.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives Geometric ring annuloplasty has shown promise during bicuspid aortic valve repair for aortic insufficiency. This study examined early outcomes of bicuspid aortic valve repair associated with proximal aortic aneurysm replacement. Methods From September 2017 to November, 2021, 127 patients underwent bicuspid aortic valve repair with concomitant proximal aneurysm reconstruction. Patient age was 50.6 ± 12.7 years (mean ± standard deviation), male gender was 83%, New York Heart Association Class was 2 (1-2) (median [interquartile range]), and preoperative aortic insufficiency grade was 3 (2-4). Ascending aortic diameter was 50 (46-54) mm, and all patients had ascending aortic replacement. Forty patients had sinus diameters greater than 45 mm, prompting remodeling root procedures. A total of 105 patients had Sievers type 1 valves, 3 patients had type 0, and 7 patients had type 2. A total of 118 patients had primarily right/left fusion, 8 patients had right/nonfusion, and 1 patient had left/nonfusion. Leaflet reconstruction used central leaflet plication and cleft closure, with limited ultrasonic decalcification in 31 patients. Results Ring size was 23 (21-23) mm, and 26 of 40 root procedures were selective nonfused sinus replacements. Aortic clamp time was 139 (112-170) minutes, and bypass time was 178 (138-217) minutes. Postrepair aortic insufficiency grade was 0 (0-0) (P < .0001), and mean valve gradient was 10 (7-14) mm Hg. No early and 1 late mortality occurred. Four patients required reoperation for bleeding, and 4 patients required pacemakers. At a mean follow-up of 20 months (maximal 93), there were no valve-related complications, 5 late repair failures prompting valve replacement, and 1 death due to Coronavirus Disease 2019. Conclusions Geometric ring annuloplasty for bicuspid aortic valve repair with proximal aortic aneurysm reconstruction is safe and associated with good early outcomes. Further experience and follow-up will help inform long-term durability.
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Affiliation(s)
- Marc W. Gerdisch
- Department of Cardiac Surgery, Franciscan Health Indianapolis, Indianapolis, Ind
- Address for reprints: Marc W. Gerdisch, MD, Department of Cardiac Surgery, Franciscan Health Indianapolis, Indianapolis, IN 46237.
| | - T. Brett Reece
- Department of Cardiac Surgery, University of Colorado, Aurora, Colo
| | - Dominic Emerson
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Los Angeles, Calif
| | - Richard S. Downey
- Department of Cardiac Surgery, University of Michigan, Muskegon, Mich
| | - Geoffrey B. Blossom
- Department of Cardiac Surgery, Ohio Health Riverside Methodist Hospital, Columbus, Ohio
| | - Arun Singhal
- Department of Cardiac Surgery, University of Iowa, Iowa City, Iowa
| | - Joshua N. Baker
- Department of Cardiac Surgery, Missouri Baptist Hospital, St Louis, Mo
| | - Theodor J.M. Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Vinay Badhwar
- Department of Cardiac Surgery, West Virginia University, Morgantown, WVa
| | - BAVr Working GroupTrentoAlfredoaChikweJoannaaWeiLawrence M.bGlotzbachJason P.cJamesTimothy W.dQuinnReed D.eWolfeJ. AlanfYamaneKentarogCopeJeffrey T.gSolemaniBehzadgTakayamaHiroohRodriguezVictor M.iMurashitaTakashijVoellerRochus K.kSiMing-SinglLevackMelissamBurkeChris R.nMoonMarc R.oKraevAlexanderpJasinskiMarek J.qStavridisGeorgiosrRankinJ. ScottbCedars Sinai Medical Center, Los Angeles, CalifWest Virginia University, Morgantown, WVaUniversity of Utah, Salt Lake City, UtahSt Joseph's Medical Center, Tacoma, WashMaine Medical Center, Portland, MaineNortheast Georgia Medical Center, Gainesville, GaPennsylvania State University, Hershey, PaColumbia Presbyterian Medical Center, New York, NYUniversity of California Davis, Sacramento, CalifUniversity of Missouri, Columbia, MoUniversity of Minnesota, Minneapolis, MinnUniversity of Michigan, Ann Arbor, MichVanderbilt University Medical Center, Nashville, TennUniversity of Washington, Seattle, WashWashington University Medical Center, St Louis, MoBillings Clinic, Billings, MontWroclaw Medical University, Wroclaw, PolandOnassis Heart Center, Athens, Greece
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Moront MG, Woodward MK, Essandoh MK, Avery EG, Reece TB, Brzezinski M, Spiess B, Shore-Lesserson L, Chen J, Henriquez W, Barceló M, Despotis G, Karkouti K, Levy JH, Ranucci M, Mondou E. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Preoperative Antithrombin Supplementation in Patients at Risk for Antithrombin Deficiency After Cardiac Surgery. Anesth Analg 2022; 135:757-768. [PMID: 35877927 DOI: 10.1213/ane.0000000000006145] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Antithrombin (AT) activity is reduced during cardiac operations with cardiopulmonary bypass (CPB), which is associated with adverse outcomes. Preoperative AT supplementation, to achieve >58% and <100% AT activity, may potentially reduce postoperative morbidity and mortality in cardiac operations with CPB. This prospective, multicenter, randomized, double-blind, placebo-controlled study was designed to evaluate the safety and efficacy of preoperative treatment with AT supplementation in patients at risk for low AT activity after undergoing cardiac surgery with CPB. METHODS A total of 425 adult patients were randomized (1:1) to receive either a single dose of AT (n = 213) to achieve an absolute increase of 20% above pretreatment AT activity or placebo (n = 212) before surgery. The study duration was approximately 7 weeks. The primary efficacy end point was the percentage of patients with any component of a major morbidity composite (postoperative mortality, stroke, acute kidney injury [AKI], surgical reexploration, arterial or venous thromboembolic events, prolonged mechanical ventilation, and infection) in the 2 groups. Secondary end points included AT activity, blood loss, transfusion requirements, duration of intensive care unit (ICU), and hospital stays. Safety was also assessed. RESULTS Overall, 399 patients (men, n = 300, 75.2%) with a mean (standard deviation [SD]) age of 66.1 (11.7) years, with the majority undergoing complex surgical procedures (n = 266, 67.9%), were analyzed. No differences in the percentage of patients experiencing morbidity composite outcomes between groups were observed (AT-treated 68/198 [34.3%] versus placebo 58/194 [29.9%]; P = .332; relative risk, 1.15). After AT infusion, AT activity was significantly higher in the AT group (108% [42-143]) versus placebo group (76% [40-110]), and lasted up to postoperative day 2. At ICU, the frequency of patients with AT activity ≥58% in the AT group (81.5%) was significantly higher (P < .001) versus placebo group (43.2%). Secondary end point analysis did not show any advantage of AT over placebo group. There were significantly more patients with AKI (P < .001) in the AT group (23/198; 11.6%) than in the placebo group (5/194, 2.6%). Safety results showed no differences in treatment-emergent adverse events nor bleeding events between groups. CONCLUSIONS AT supplementation did not attenuate adverse postoperative outcomes in our cohort of patients undergoing cardiac surgery with CPB.
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Affiliation(s)
- Michael George Moront
- From the, Department of Cardiothoracic Sugery, Promedical Toledo Hospital, Toledo, Ohio
| | | | - Michael K Essandoh
- Department of Anesthesiology' Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Edwin G Avery
- Department of Anesthesiology and Perioperative Medicine, University Hospital Case Medical Center, Cleveland, Ohio
| | - T Brett Reece
- Department of Surgery' Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado
| | - Marek Brzezinski
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Bruce Spiess
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | | | - Junliang Chen
- Bioscience Research Group, Grifols, Barcelona, Spain
| | | | | | - George Despotis
- Departments of Pathology, Immunology and Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jerrold H Levy
- Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, North Carolina
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCSS Policlinico San Donato, Milan, Italy
| | - Elsa Mondou
- Bioscience Research Group, Grifols, Barcelona, Spain
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21
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Kemp C, Ghincea CV, Feng Z, Gergen AK, Cleveland JC, Rove JY, Aftab M, Fullerton D, Reece TB. Evaluating the risk of spinal cord ischemia in zone 2 frozen elephant trunk replacement. Am J Surg 2022; 224:1057-1061. [DOI: 10.1016/j.amjsurg.2022.07.011] [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] [Received: 12/07/2021] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 11/01/2022]
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22
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Hoffman JRH, Higa KC, Lin Y, Reece TB, Cleveland JC, Aftab M, Rove JY. Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling. Semin Cardiothorac Vasc Anesth 2022; 26:154-161. [PMID: 35591803 DOI: 10.1177/10892532221101298] [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: 11/17/2022]
Abstract
Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.
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Affiliation(s)
| | - Kelly C Higa
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Yihan Lin
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
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23
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163:1231-1249. [PMID: 35090765 DOI: 10.1016/j.jtcvs.2021.11.091] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Md
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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24
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. Ann Thorac Surg 2022; 113:1073-1092. [PMID: 35090687 DOI: 10.1016/j.athoracsur.2021.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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25
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Gergen AK, Kemp C, Ghincea CV, Feng Z, Ikeno Y, Aftab M, Reece TB. Direct Innominate Artery Cannulation versus Side Graft for Selective Antegrade Cerebral Perfusion during Aortic Hemiarch Replacement. Aorta (Stamford) 2022; 10:26-31. [PMID: 35640584 PMCID: PMC9179210 DOI: 10.1055/s-0042-1744136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background
Selective antegrade cerebral perfusion (SACP) has become our preferred method for cerebral protection during open arch cases. While the initial approach involved sewing a graft to the innominate artery as the arterial cannulation site, our access strategy has since evolved to central aortic cannulation with use of a percutaneous cannula in the innominate for SACP. We hypothesized that SACP delivered via direct innominate cannulation using a 12- or 14-Fr cannula results in equivalent outcomes to cases utilizing a side graft.
Methods
This was a single-center, retrospective analysis of 211 adult patients who underwent elective hemiarch replacement using hypothermic circulatory arrest with SACP via the innominate artery between 2012 and 2020. Urgent and emergent cases were excluded.
Results
A side graft sutured to the innominate was utilized in 81% (
n
= 171) of patients, while direct innominate artery cannulation was performed in 19% (
n
= 40) of patients. Baseline patient characteristics were similar between groups aside from a higher baseline creatinine in the direct cannulation group (1.3 vs. 0.9,
p
= 0.032). Patients undergoing direct cannulation demonstrated shorter cardiopulmonary bypass time (132.7 vs. 154.9 minutes,
p
= 0.020) and shorter circulatory arrest time (8.1 vs. 10.9 minutes,
p
= 0.004). Nadir bladder temperature did not significantly differ between groups (27.2°C for side graft vs. 27.6°C for direct cannulation,
p
= 0.088). There were no significant differences in postoperative outcomes.
Conclusion
Direct cannulation of the innominate artery with a 12- or 14-Fr cannula for SACP during hemiarch replacement is a safe alternative to using a sutured side graft. While cardiopulmonary bypass and circulatory arrest times appear improved, this is likely attributable to accumulation of experience and proficiency in technique. However, direct innominate artery cannulation may facilitate quicker completion of these procedures by eliminating the time necessary to suture a graft to the innominate artery.
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Affiliation(s)
- Anna K. Gergen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Cenea Kemp
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Christian V. Ghincea
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Zihan Feng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Yuki Ikeno
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - T. Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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26
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Kemp C, Ikeno Y, Aftab M, Reece TB. Cerebrospinal fluid drainage in thoracic endovascular aortic repair: mandatory access but tailored placement. Ann Cardiothorac Surg 2022; 11:53-55. [DOI: 10.21037/acs-2021-taes-12] [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] [Received: 04/27/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
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27
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Reutersberg B, Trimarchi S, Gilon D, Kaiser C, Harris K, Shalhub S, Reece TB, Nienaber C, Ehrlich M, Isselbacher E, De Oliveira N, Montgomery D, Eagle K, Tolva V, Chen EP, Eckstein HH. Pleural effusion: a potential surrogate marker for higher-risk patients with acute type B aortic dissections. Eur J Cardiothorac Surg 2021; 61:816-825. [PMID: 34966915 DOI: 10.1093/ejcts/ezab540] [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: 04/22/2021] [Revised: 08/31/2021] [Accepted: 11/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pleural effusions (PEffs) are known to occur in type B acute aortic dissection (TBAAD). We investigated the relationship between pleural effusion and the development of early or late complications following TBAAD. METHODS The incidence of PEff (defined as at least an obliteration of the costophrenic angle in a frontal projection) diagnosed on their initial chest X-ray in patients with TBAAD enrolled in the International Registry of Acute Aortic Dissection was examined. We analysed in-hospital outcomes and long-term survival separately for patients with and without PEffs (PEff+ versus PEff-, respectively). RESULTS Included were 1252 patients with TBAAD, of whom 224 (17.9%) had PEff. Compared with patients without PEff in the initial chest X-ray, these were significantly older [mean age 67 (SD: 14.7) vs 63.4 (SD: 14.2) years, P = 0.001] and more often female (42.4% vs 34.2%, P = 0.021) and had more comorbidities (known aortic aneurysm, chronic obstructive pulmonary disease, chronic renal failure, diabetes, congestive heart failure or mitral valve disease). PEff was associated with higher in-hospital mortality (16.1% vs 9.1%, P = 0.002) and increased rates of neurological complications (16.6% vs 11.1%, P = 0.029), acute renal failure (27.2% vs 19.7%, P = 0.017) and hypotension (17.4% vs 9.6%, P = 0.001). In addition, patients with PEff underwent aortic repair more frequently (44.6% vs 32.5%, P < 0.001). In the long-term patients with PEff showed lower 5-year post-discharge survival (67.6% vs 77.6%, P = 0.004). Multivariable analysis with propensity-matched data showed that PEff was not an independent risk factor for in-hospital mortality (odds ratio 1.9, 95% CI 0.8-4.4, P = 0.141). CONCLUSIONS Patients with TBAAD and evidence of PEff showed a higher in-hospital mortality, are more likely to develop additional in-hospital complications and have a decreased likelihood of survival during follow-up. However, according to propensity-matched analysis, PEff remained not as an independent predictor of worse outcome but might serve as an early surrogate marker to identify higher-risk patients.
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Affiliation(s)
- Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Munich Aortic Center (MAC), Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Santi Trimarchi
- Department of Clinical and Community Sciences-University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dan Gilon
- Department of Noninvasive Cardiology and Echocardiography, Heart Institute, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Jerusalem, Israel
| | - Clayton Kaiser
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Harris
- Department of Cardiology, Minneapolis Heart Institute, Abbott, Northwestern Hospital, Minneapolis, MN, USA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christoph Nienaber
- Department of Cardiology, The Royal Brompton & Harefield NHS Trust, Cardiology and Aortic Centre, Imperial College, London, UK
| | - Marek Ehrlich
- Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
| | - Eric Isselbacher
- Division of Cardiac Surgery, Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nilto De Oliveira
- Division of Cardiac Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Montgomery
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.,Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Kim Eagle
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.,Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Valerio Tolva
- Department of Vascular Surgery, Policlinico di Monza Hospital, Centro Cuore. Policlinico di Monza, Monza, Italy
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Munich Aortic Center (MAC), Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
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28
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Gergen AK, Meguid RA, Reece TB, Aftab M. Endovascular aortic repair of Kommerell diverticulum associated with aberrant left subclavian artery. Ann Cardiothorac Surg 2021; 10:807-809. [PMID: 34926187 DOI: 10.21037/acs-2021-taes-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Anna K Gergen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research (ACCORDS), Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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29
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Bonaca MP, Reece TB. Novel views on finding an old foe: non-contrast computed tomography in the diagnosis of acute aortic syndromes. Eur Heart J Acute Cardiovasc Care 2021; 10:976-977. [PMID: 34791140 DOI: 10.1093/ehjacc/zuab099] [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] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marc P Bonaca
- Cardiovascular Division, Department of Medicine, University of Colorado School of Medicine, 13199 E. Montview Blvd., Rm. 200, Aurora, CO, USA.,Department of Surgery, University of Colorado School of Medicine, 13199 E. Montview Blvd., Aurora, CO, USA
| | - T Brett Reece
- Cardiovascular Division, Department of Medicine, University of Colorado School of Medicine, 13199 E. Montview Blvd., Rm. 200, Aurora, CO, USA.,Department of Surgery, University of Colorado School of Medicine, 13199 E. Montview Blvd., Aurora, CO, USA
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30
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Abstract
Acute aortic syndromes, classified into aortic dissection, intramural hematoma, and penetrating aortic ulcer, are associated with high early mortality for which early diagnosis and management are crucial to optimize outcomes. Patients often present with nonspecific clinical symptoms and signs; therefore, it is important for providers to maintain a high index of suspicion for acute aortic syndromes. Electrocardiogram-gated computed tomographic angiography of the chest, abdomen, and pelvis is currently the most practical imaging modality for diagnosis and identification of complications. Evolution in surgical techniques and the development of aortic endografts have improved patient outcomes, but randomized trials are still needed.
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Affiliation(s)
- R Kevin Rogers
- Division of Cardiology, University of Colorado, School of Medicine, Section of Vascular Medicine, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO 80045, USA.
| | - T Brett Reece
- Division of Cardiovascular Surgery, University of Colorado, School of Medicine, 12631 East 17th Avenue, Room 6111, Aurora, CO 80045, USA
| | - Marc P Bonaca
- Division of Cardiology, University of Colorado, School of Medicine, Section of Vascular Medicine, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO 80045, USA; CPC Clinical Research, 2115 North Scranton Street Suite 2040, Aurora, CO 80045, USA
| | - Connie N Hess
- Division of Cardiology, University of Colorado, School of Medicine, Section of Vascular Medicine, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO 80045, USA; CPC Clinical Research, 2115 North Scranton Street Suite 2040, Aurora, CO 80045, USA
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31
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Ghincea CV, Aftab M, Ikeno Y, Mesher AL, Reece TB. Cerebral protection in type A aortic dissection. J Vis Surg 2021. [DOI: 10.21037/jovs-20-82] [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: 11/06/2022]
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32
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Lin Y, Aftab M, Reece TB. Commentary: Intraoperative neuromonitoring: FAST to FASTER response to neurologic complication. J Thorac Cardiovasc Surg 2021; 165:1984. [PMID: 34531041 DOI: 10.1016/j.jtcvs.2021.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yihan Lin
- Department of Cardiothoracic Surgery, University of Colorado, Aurora, Colo
| | - Muhammad Aftab
- Department of Cardiothoracic Surgery, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado, Aurora, Colo.
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33
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Cain MT, Reece TB. Commentary: Antegrade cerebral perfusion versus retrograde cerebral perfusion: If only it was that easy. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01230-7. [PMID: 34556358 DOI: 10.1016/j.jtcvs.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Michael T Cain
- Department of Cardiothoracic Surgery, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado, Aurora, Colo.
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34
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Reece TB, Mesher AL, Aftab M. Commentary: Somewhere between the root or no root argument: Selective sinus replacement. JTCVS Open 2021; 6:106-107. [PMID: 36003562 PMCID: PMC9390585 DOI: 10.1016/j.xjon.2020.12.019] [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: 12/24/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
Affiliation(s)
- T. Brett Reece
- Address for reprints: T. Brett Reece, MD, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, MS C310, AO1 Rm 6610, Aurora, CO 80045.
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35
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Abstract
COVID-19 has affected every aspect of life over the last year. This article reviews some of the effects that the pandemic had on cardiac surgery including volumes, ethical concerns with resource-intense procedures like dissection and transplant, and ECMO for COVID-19-derived refractory respiratory failure.
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Affiliation(s)
| | | | | | - Jay D Pal
- University of Colorado, Aurora, CO, USA
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36
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Venardos N, Gergen AK, Jarrett M, Weyant MJ, Reece TB, Meng X, Fullerton DA. Warfarin Induces Calcification of the Aortic Valve via ERK1/2 and β-Catenin Signaling. Ann Thorac Surg 2021; 113:824-835. [PMID: 33901456 PMCID: PMC10109508 DOI: 10.1016/j.athoracsur.2021.03.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent clinical evidence suggests an association between warfarin use and calcification of the aortic valve. We sought to determine the effect of warfarin on aortic valve interstitial cell (AVIC) osteogenic protein expression and the signaling pathways by which this effect is mediated. METHODS Human AVICs were isolated from normal aortic valves of patients undergoing cardiac transplantation while diseased AVICs were isolated from patients undergoing aortic valve replacement for aortic stenosis. AVICs were treated with various anticoagulants and osteogenic protein expression was evaluated using immunoblotting. Phosphorylation of LRP6 and ERK1/2 was evaluated following treatment with warfarin. AVICs were pretreated with LRP6 inhibitor dkk1 and ERK1/2 inhibitor PD98059 followed by treatment with warfarin and osteogenic protein expression was evaluated. RESULTS Warfarin, but not heparin or dabigatran, significantly increased Runx-2 and Osx expression in both normal and diseased human AVICs. Upregulation of β-catenin protein expression and nuclear translocation occurred in diseased AVICs, but not normal AVICs after warfarin treatment. Warfarin induced phosphorylation of LRP6 in diseased AVICs only, and phosphorylation of ERK1/2 in both normal and diseased AVICs. LRP6 inhibition attenuated warfarin-induced Runx-2 expression in diseased AVICs. ERK1/2 inhibition attenuated warfarin-induced Runx-2 expression in both normal and diseased AVICs. CONCLUSIONS Warfarin induces osteogenic activity in normal and diseased isolated human AVICs. This effect is mediated by ERK1/2 in both diseased and normal AVICs, but in diseased AVICs, β-catenin signaling also plays a role. These results implicate the role of warfarin in aortic valve calcification and highlight potential mechanisms for warfarin-induced aortic stenosis.
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Affiliation(s)
- Neil Venardos
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA
| | - Anna K Gergen
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA.
| | - Michael Jarrett
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA
| | - Michael J Weyant
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA
| | - T Brett Reece
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA
| | - Xianzhong Meng
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA
| | - David A Fullerton
- University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Aurora, CO, USA
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37
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Venardos N, Reece TB. Commentary: Anomalous retro-aortic circumflex artery off of the right coronary artery: Whatever works! JTCVS Tech 2021; 7:149-150. [PMID: 34318231 PMCID: PMC8311677 DOI: 10.1016/j.xjtc.2021.02.017] [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: 02/04/2021] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - T. Brett Reece
- Address for reprints: T. Brett Reece, MD, Department of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Room 5401, Mail Stop C-291, Aurora, CO 80045.
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38
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39
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Reece TB, Aftab M. Commentary: Preparing for the worst, expecting the worst can make it better. J Thorac Cardiovasc Surg 2020; 163:1265-1266. [PMID: 33341275 DOI: 10.1016/j.jtcvs.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Affiliation(s)
- T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo.
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
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40
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Jarrett MJ, Houk AK, McCuistion PE, Weyant MJ, Reece TB, Meng X, Fullerton DA. Wnt Signaling Mediates Pro-Fibrogenic Activity in Human Aortic Valve Interstitial Cells. Ann Thorac Surg 2020; 112:519-525. [PMID: 33189669 DOI: 10.1016/j.athoracsur.2020.08.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/27/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Proinflammatory activation of toll-like receptor-4 (TLR4) drives phenotypic changes in aortic valve interstitial cells (AVICs) and produces a fibrogenic phenotype that mediates valvular fibrosis and contributes to aortic stenosis. Prior work identified upregulated Wnt signaling in AVICs taken from valves affected by aortic stenosis. Our purpose was to determine the contribution of Wnt signaling to TLR4-dependent fibrogenic activity in isolated human AVICs. METHODS Human AVICs were isolated from hearts explanted for cardiac transplantation (N = 4). To test whether Wnt signaling contributed to TLR4-dependent fibrogenic activity, AVICs were treated with Wnt inhibitor (Dkk1) prior to TLR4 activation (LPS) and fibrogenic markers assessed. To determine the mediator of TLR4-to-Wnt signaling, expression of the key Wnt ligand, Wnt3a, was assessed after TLR4 activation and neutralizing antibodies confirmed the identity of the mediator. Fibrogenic activity was assessed after AVICs were treated with recombinant Wnt3a. Statistics were by analysis of variance (P < .05). RESULTS TLR4 activation upregulated in vitro collagen deposition, type IV collagen and MMP2 expression, and Dkk1 inhibited these responses (P < .05). Expression of Wnt3a was upregulated after TLR4 activation (P < .05). Anti-Wnt3a neutralizing antibodies abrogated TLR4-dependent type IV collagen and MMP2 expression (P < .05). Wnt3a upregulated type IV collagen and MMP2 expression independent of TLR4 activation (P < .05). CONCLUSIONS This study found that TLR4-dependent fibrogenic activity was mediated through Wnt signaling. The mediator of profibrogenic TLR4-to-Wnt signaling was a key Wnt ligand, Wnt3a. The abrogation of TLR4-induced fibrogenic activity in human AVICs by Wnt blockade illustrates a potential therapeutic role for Wnt inhibition in treatment and/or prevention of aortic stenosis.
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Affiliation(s)
- Michael J Jarrett
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Anna K Houk
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Peyton E McCuistion
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Weyant
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - T Brett Reece
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Xianzhong Meng
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - David A Fullerton
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
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41
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Venardos N, Aftab M, Reece TB. Simple Surveillance Is Not So Simple. Ann Thorac Surg 2020; 111:621-622. [PMID: 33080232 DOI: 10.1016/j.athoracsur.2020.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Neil Venardos
- Department of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Rm 6602, MS C310, PO Box 6511, Aurora, CO 80045
| | - Muhammad Aftab
- Department of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Rm 6602, MS C310, PO Box 6511, Aurora, CO 80045
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado, 12631 E 17th Ave, Rm 6602, MS C310, PO Box 6511, Aurora, CO 80045.
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42
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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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43
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Lin Y, Aftab M, Reece TB. Commentary: Obviously Malperfusion in Dissection Is Bad, But Severe Acidosis May Be Unsurmountable. Semin Thorac Cardiovasc Surg 2020; 32:681-682. [PMID: 32610189 DOI: 10.1053/j.semtcvs.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Yihan Lin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
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44
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Griffin BR, Bronsert M, Reece TB, Pal JD, Cleveland JC, Fullerton DA, Faubel S, Aftab M. Creatinine elevations from baseline at the time of cardiac surgery are associated with postoperative complications. J Thorac Cardiovasc Surg 2020; 163:1378-1387. [PMID: 32739165 DOI: 10.1016/j.jtcvs.2020.03.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/27/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Baseline kidney function is a key predictor of postoperative morbidity and mortality. Whether an increased creatinine at the time of surgery, compared with the lowest creatinine in the 3 months before surgery, is associated with poor outcomes has not been evaluated. We examined whether creatinine elevations from "baseline" were associated with adverse postoperative outcomes. METHODS A total of 1486 patients who underwent cardiac surgery at the University of Colorado Hospital between January 2011 and May 2016 met inclusion criteria. "Change in creatinine from baseline" was defined as the difference between the immediate presurgical creatinine value and the lowest creatinine value within 3 months preceding surgery. Outcomes evaluated were in-hospital mortality, postoperative infection, postoperative stroke, development of stage 3 acute kidney injury, intensive care unit length of stay, and hospital length of stay. Outcomes were adjusted using a balancing score to account for differences in patient characteristics. RESULTS There were significant increases in the odds of postoperative infection (odds ratio, 1.17; confidence interval, 1.02-1.34; per 0.1 mg/dL increase in creatinine), stage 3 acute kidney injury (odds ratio, 1.44; confidence interval; 1.18-1.75), intensive care unit length of stay (odds ratio, 1.13; confidence interval, 1.01-1.26), and hospital length of stay (odds ratio, 1.09; confidence interval, 1.05-1.13). There was a significant increase in mortality in the unadjusted analysis, although not after adjustment using a balancing score. There was no association with postoperative stroke. CONCLUSIONS Elevations in creatinine at the time of surgery above the "baseline" level are associated with increased postoperative morbidity. Baseline creatinine should be established before surgery, and small changes in creatinine should trigger heightened vigilance in the postoperative period.
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Affiliation(s)
- Benjamin R Griffin
- Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and Surgical Outcomes and Applied Research, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Jay D Pal
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Sarah Faubel
- Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo.
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45
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Ghincea CV, Ikeno Y, Weyant MJ, Mitchell JD, Aftab M, Reece TB. Right Thoracoscopic Aberrant Right Subclavian Artery Division and Subclavian-Carotid Transposition. Ann Thorac Surg 2020; 110:e431-e433. [PMID: 32407854 DOI: 10.1016/j.athoracsur.2020.03.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Video-assisted thoracoscopic surgical division of obstructive congenital vascular rings has been demonstrated to be a safe technique in the setting of right-sided or double aortic arch, requiring a left-sided thoracic approach. This report describes 2 cases of aberrant right subclavian artery division using right video-assisted thoracoscopic surgery and subclavian-carotid transposition. This approach is safe and feasible in the management of symptomatic aberrant right subclavian artery without the morbidity of a thoracotomy incision, although patients require ongoing surveillance.
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Affiliation(s)
- Christian V Ghincea
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Yuki Ikeno
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Weyant
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado.
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46
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Aftab M, Reece TB. Commentary: Like politics, transfusion practice is local. J Thorac Cardiovasc Surg 2020; 163:1026-1027. [PMID: 33268111 DOI: 10.1016/j.jtcvs.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo.
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47
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Mesher AL, Aftab M, Reece TB. Commentary: Beauty, and durability, is in the eye of the needle holder. J Thorac Cardiovasc Surg 2020; 161:479-480. [PMID: 32387161 DOI: 10.1016/j.jtcvs.2020.03.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Andrew L Mesher
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colo.
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48
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Ghincea CV, Reece TB, Aftab M, Cleveland JC, Pal JD. Noteworthy Cardiac Literature 2019: Cerebral Protection, Zone 2 Arch, Intravascular Ultrasonography in Dissection, Heart Allocation, and Mitral Durability. Semin Cardiothorac Vasc Anesth 2020; 24:187-191. [PMID: 32342759 DOI: 10.1177/1089253220920146] [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: 11/15/2022]
Abstract
The year of 2019 continues to have notable literature advancing the practice of cardiac surgery. In this article, topics of discussion will include the evolution of cerebral protection, the advancement of arch surgical techniques, the heart transplant allocation system, and mitral repair approach and durability.
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Affiliation(s)
| | | | | | | | - Jay D Pal
- University of Colorado, Aurora, CO, USA
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49
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Reece TB, Aftab M. Commentary: Dissection in the elderly-do the right thing, fix them! J Thorac Cardiovasc Surg 2020; 163:13. [PMID: 32362387 DOI: 10.1016/j.jtcvs.2020.03.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Affiliation(s)
- T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
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50
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Reece TB. Commentary: Redo root surgery: Complicated, but feasible. J Thorac Cardiovasc Surg 2020; 162:1073-1074. [PMID: 32171481 DOI: 10.1016/j.jtcvs.2020.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.
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