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153. The Critical Biomechanics of Aortomitral Angle and Systolic Anterior Motion: Engineering Native Ex Vivo Simulation

Author

Park, Matthew H., primary, Imbrie-Moore, Annabel M., additional, Zhu, Yuanjia, additional, Wilkerson, Robert J., additional, Wang, Hanjay, additional, Park, Grant H., additional, Wu, Catherine A., additional, Pandya, Pearly K., additional, Mullis, Danielle M., additional, Marin-Cuartas, Mateo, additional, and Woo, Y. Joseph, additional

Published
2022
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156. Association of Volume and Outcomes in 234 556 Patients Undergoing Surgical Aortic Valve Replacement

Author

Thourani, Vinod H., primary, Brennan, James M., additional, Edelman, J. James, additional, Thibault, Dylan, additional, Jawitz, Oliver K., additional, Bavaria, Joseph E., additional, Higgins, Robert S.D., additional, Sabik, Joseph F., additional, Prager, Richard L., additional, Dearani, Joseph A., additional, MacGillivray, Thomas E., additional, Badhwar, Vinay, additional, Svensson, Lars G., additional, Reardon, Michael J., additional, Shahian, David M., additional, Jacobs, Jeffrey P., additional, Ailawadi, Gorav, additional, Szeto, Wilson Y., additional, Desai, Nimesh, additional, Roselli, Eric E., additional, Woo, Y. Joseph, additional, Vemulapalli, Sreek, additional, Carroll, John D., additional, Yadav, Pradeep, additional, Malaisrie, S. Chris, additional, Russo, Mark, additional, Nguyen, Tom C., additional, Kaneko, Tsuyoshi, additional, Tang, Gilbert, additional, Ruel, Marc, additional, Chikwe, Joanna, additional, Lee, Richard, additional, Habib, Robert H., additional, George, Isaac, additional, Leon, Martin B., additional, and Mack, Michael J., additional

Published
2022
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157. A value-based approach to optimize red blood cell transfusion in patients receiving extracorporeal membrane oxygenation

Author

Shudo, Yasuhiro, primary, Cheng, Nathalie, additional, He, Hao, additional, Rosenberg, Corinne, additional, Hiesinger, William, additional, Hadhazy, Eric, additional, Shepard, John, additional, Krishna, Purnima, additional, Resnik, Josh, additional, Fong, Robyn, additional, Hill, Charles, additional, Hsu, Joe L, additional, Maggio, Paul M, additional, Chang, Sang-Ick, additional, Boyd, Jack H, additional, and Woo, Y Joseph, additional

Published
2022
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168. Fractional flow reserve–guided PCI as compared with coronary bypass surgery

Author

Fearon, William F., Zimmermann, Frederik M., de Bruyne, Bernard, Piroth, Zsolt, van Straten, Albert H.M., Szekely, Laszlo, Davidavičius, Giedrius, Kalinauskas, Gintaras, Mansour, Samer, Kharbanda, Rajesh, Östlund-Papadogeorgos, Nikolaos, Aminian, Adel, Oldroyd, Keith G., Al-Attar, Nawwar, Jagic, Nikola, Jan-Henk, E. Dambrink, Kala, Petr, Angerås, Oskar, MacCarthy, Philip, Wendler, Olaf, Casselman, Filip, Witt, Nils, Mavromatis, Kreton, Miner, Steven E.S., Sarma, Jaydeep, Engstrøm, Thomas, Christiansen, Evald H., Tonino, Pim A.L., Reardon, Michael J., Lu, Di, Ding, Victoria Y., Kobayashi, Yuhei, Hlatky, Mark A., Mahaffey, Kenneth W., Desai, Manisha, Woo, Y. Joseph, Yeung, Alan C., Pijls, Nico H.J., Fearon, William F., Zimmermann, Frederik M., de Bruyne, Bernard, Piroth, Zsolt, van Straten, Albert H.M., Szekely, Laszlo, Davidavičius, Giedrius, Kalinauskas, Gintaras, Mansour, Samer, Kharbanda, Rajesh, Östlund-Papadogeorgos, Nikolaos, Aminian, Adel, Oldroyd, Keith G., Al-Attar, Nawwar, Jagic, Nikola, Jan-Henk, E. Dambrink, Kala, Petr, Angerås, Oskar, MacCarthy, Philip, Wendler, Olaf, Casselman, Filip, Witt, Nils, Mavromatis, Kreton, Miner, Steven E.S., Sarma, Jaydeep, Engstrøm, Thomas, Christiansen, Evald H., Tonino, Pim A.L., Reardon, Michael J., Lu, Di, Ding, Victoria Y., Kobayashi, Yuhei, Hlatky, Mark A., Mahaffey, Kenneth W., Desai, Manisha, Woo, Y. Joseph, Yeung, Alan C., and Pijls, Nico H.J.

Abstract

BACKGROUND Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking. METHODS In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed. RESULTS A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (±SD) of 3.7±1.9 stents, and those assigned to undergo CABG received 3.4±1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P=0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group. CONCLUSIONS In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a co

Published
2022

170. Abstract 19629: Tissue-Engineered Smooth Muscle Cell-Endothelial Progenitor Cell Bi-level Cell-Sheets Combined With Internal Mammary Artery Myocardial Implantation Rescue Myocardium in Diabetic Cardiomyopathy With Acute Myocardial Infarction Model

Author

Kawamura, Masashi, Paulsen, Michael J, Shudo, Yasuhiro, von Bornstaedt, Daniel, Goldstone, Andrew B, Steele, Amanda N, Stapleton, Lyndsay M, Jaatinen, Kevin J, Eskandari, Anahita, Farry, Justin, Truong, Vi N, Thakore, Akshara, Miyagawa, Shigeru, Sawa, Yoshiki, and Woo, Y. Joseph

Published
2017

173. Surgical management of severe mitral annular calcification.

Author

Elde, Stefan, Zhu, Yuanjia, MacArthur, John W., and Woo, Y. Joseph

Abstract

Background: Surgical management of severe mitral annular calcification (MAC) presents a challenging problem for even the most experienced surgeons. Preoperative planning is the most effective strategy to mitigate risk in these scenarios. MAC alone should not disqualify a patient from consideration for mitral valve repair, although the presence of concurrent greater than moderate stenosis warrants consideration of mitral valve replacement. Methods: While repair and replacement techniques for mitral regurgitation in the setting of MAC overlap with those used to repair a non-calcified mitral apparatus, there are unique considerations to the surgical conduct of these procedures. Specifically, this article describes techniques that may be employed when the severity of MAC precludes typical repair or replacement strategies. Results: Between 2014 and 2021, 77 patients were operated on by a single surgeon for mitral valve disease complicated by severe MAC. Using the systematic approach described herein, 1-year mortality was 7.8% and overall mortality over a follow-up period extending 1 to 8 years was 9.1%. Conclusions: Despite the inherent challenges of mitral valve repair or replacement in the setting of severe MAC, a systematic approach beginning with preoperative planning, modification of annular suture placement, and techniques to mitigate severe complications have, in our experience, resulting in a reliable methodology for managing severe MAC with excellent outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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181. Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts

Author

Shudo, Yasuhiro, primary, Alassar, Aiman, additional, Wang, Hanjay, additional, Lingala, Bharathi, additional, He, Hao, additional, Zhu, Yuanjia, additional, Hiesinger, William, additional, MacArthur, John W., additional, Boyd, Jack H., additional, Lee, Anson M., additional, Currie, Maria, additional, and Woo, Y. Joseph, additional

Published
2022
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182. Electrophysiologic Conservation of Epicardial Conduction Dynamics After Myocardial Infarction and Natural Heart Regeneration in Newborn Piglets

Author

Wang, Hanjay, primary, Pong, Terrence, additional, Obafemi, Oluwatomisin O., additional, Lucian, Haley J., additional, Aparicio-Valenzuela, Joy, additional, Tran, Nicholas A., additional, Mullis, Danielle M., additional, Elde, Stefan, additional, Tada, Yuko, additional, Baker, Sam W., additional, Wang, Caroline Y., additional, Cyr, Kevin J., additional, Paulsen, Michael J., additional, Zhu, Yuanjia, additional, Lee, Anson M., additional, and Woo, Y. Joseph, additional

Published
2022
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183. Naturally aligned cell delivery platform to augment post-infarction neovasculature and ventricular remodeling

Author

Shin, Hye, primary, Thakore, Akshara, additional, Tada, Yuko, additional, Pedroza, Albert, additional, Ikeda, Gentaro, additional, Chen, Ian, additional, Chan, Doreen, additional, Jaatinen, Kevin, additional, Kawamura, Masashi, additional, Yang, Phillip, additional, Wu, Joseph, additional, Appel, Eric, additional, Fischbein, Michael, additional, Woo, Y Joseph, additional, and Shudo, Yasuhiro, additional

Published
2022
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185. List of Contributors

Author

Ascheim, Deborah D., primary, Balkan, Wayne, additional, Bareja, Akshay, additional, Bartlett, Courtney E., additional, Behfar, Atta, additional, Blackbourn, Lisle, additional, Bolli, Roberto, additional, Buja, L. Maximilian, additional, Castellanos, Angela, additional, Chaanine, Antoine H., additional, Chau, Eric, additional, Chen, Zhen, additional, Christman, Karen L., additional, Chung, Amy, additional, Cole, Robert M., additional, Cooke, John P., additional, Duckers, H.J., additional, Dzau, Victor J., additional, Ebert, Ray F., additional, Fujita, Jun, additional, Fukuda, Keiichi, additional, Gaetani, Roberto, additional, Gahremanpour, Amir, additional, Gathier, W., additional, Gelijns, Annetine C., additional, Gobin, Andrea S., additional, Gomez, José A., additional, Hajjar, Roger J., additional, Hare, Joshua M., additional, Hariharan, Nirmala, additional, Henry, Timothy D., additional, Hiesinger, William, additional, Hirsch, Alan T., additional, Hodgkinson, Conrad P., additional, Hong, Kimberly N., additional, Hong, Kyung U., additional, Ichim, Thomas E., additional, Jolicoeur, E. Marc, additional, Kodo, Kazuki, additional, Krishnan, Sandeep K., additional, Kutryk, Michael J.B., additional, Lee, David S., additional, Lee, Randall J., additional, Losordo, Douglas W., additional, Migliati, Elton, additional, Miller, Leslie W., additional, Misra, Vivek, additional, Moyé, Lem, additional, Nguyen, Nathalie, additional, Ong, Sang-Ging, additional, Orozco, Aaron, additional, Patel, Amit N., additional, Penn, Brittany M., additional, Penn, Marc S., additional, Perin, Emerson C., additional, Raval, Amish N., additional, Resende, Micheline, additional, Roelandt, Philip R., additional, Roobrouck, Valerie D., additional, Sampaio, Luiz C., additional, Savitz, Sean I., additional, Schmuck, Eric G., additional, Schulman, Ivonne Hernandez, additional, Simari, Robert D., additional, Smidt, Luis Felipe Silva, additional, Smith, Rachel Ruckdeschel, additional, Stewart, Duncan J., additional, Sussman, Mark A., additional, Swaminath, Deephak, additional, Taldone, Sabrina, additional, Taylor, Doris A., additional, Terzic, Andre, additional, Traverse, Jay H., additional, Türktaş, Z., additional, Ungerleider, Jessica, additional, Vela, Deborah, additional, Verfaillie, Catherine M., additional, Vrtovec, Bojan, additional, Weber, Thomas, additional, Woo, Y. Joseph, additional, Willerson, James T., additional, Wu, Joseph C., additional, Yaroshinsky, Alex, additional, Zangi, Lior, additional, and Zhang, Jianyi (Jay), additional

Published
2016
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186. Contributors

Author

Abbott, Brian G., primary, Abbott, J. Dawn, additional, Adams, David H., additional, Al-Atassi, Talal, additional, Al-Dameh, Ali, additional, Allen, Mark S., additional, Altorki, Nasser K., additional, Anand, Jatin, additional, Anderson, Robert H., additional, Anraku, Masaki, additional, Anyanwu, Anelechi C., additional, Arora, Amit, additional, Austin, Erle H., additional, Awtry, Eric H., additional, Bacha, Emile A., additional, Backhus, Leah M., additional, Bagai, Jayant, additional, Baillot, Richard, additional, Baird, Christopher W., additional, Barron, David J., additional, Bavaria, Joseph E., additional, Bernal, Jose M., additional, Bianco, Valentino J., additional, Bichell, David P., additional, Birgisson, Sigurbjorn, additional, Blackburn, Nick J.R., additional, Bonatti, Johannes, additional, Boodhwani, Munir, additional, Bove, Edward L., additional, Brawn, William J., additional, Brizard, Christian P., additional, Brothers, Julie A., additional, Brown, Lisa M., additional, Bryant, Ayesha S., additional, Burkhart, Harold M., additional, Caldarone, Christopher A., additional, Cannon, Jeremy W., additional, Carr, Justine M., additional, Castelvecchio, Serenella, additional, Castillo, Javier G., additional, Cecchin, Frank, additional, Cerfolio, Robert J., additional, Chahine, A. Alfred, additional, Chaikof, Elliot L., additional, Chan, Vincent, additional, Chaudhry, Sunit-Preet, additional, Chen, Frederick Y., additional, Chen, Stuart H., additional, Cheng, Aaron M., additional, Chien, Victor, additional, Chin, Alvin J., additional, Chin, Cynthia S., additional, Chiu, Peter, additional, Cleveland, Joseph C., additional, Cohn, Lawrence H., additional, Cohn, William E., additional, Colson, Yolonda L., additional, Colucci, Wilson S., additional, Cook, Andrew C., additional, Coselli, Joseph S., additional, Crawford, Todd C., additional, Culligan, Melissa, additional, Dagenais, François, additional, Damiano, Ralph J., additional, D'Amico, Thomas A., additional, Dartevelle, Philippe G., additional, David, Tirone E., additional, D'Cunha, Jonathan, additional, de la Cruz, Kim I., additional, Dearani, Joseph A., additional, DeArmond, Daniel T., additional, del Nido, Pedro J., additional, DeMeester, Tom R., additional, Demers, Philippe, additional, Demmy, Todd L., additional, Dexter, Elisabeth U., additional, Dhupar, Rajeev, additional, DiNardo, James A., additional, Doyle, Thomas P., additional, Ehsan, Afshin, additional, Khoury, Gebrine El, additional, Ellis, Ethan R., additional, Elmadhun, Nassrene Y., additional, Emani, Sitaram M., additional, Erasmus, Jeremy J., additional, Fauza, Dario O., additional, Fein, Adam S., additional, Fiedler, Amy G., additional, Foppa, Murilo, additional, Freeman, Rosario V., additional, Friedberg, Joseph, additional, Friscia, Michael, additional, Fynn-Thompson, Francis, additional, Gaynor, J. William, additional, Ge, Liang, additional, Geva, Tal, additional, Gheewala, Neil M., additional, Gillinov, A. Marc, additional, Glower, Donald D., additional, Goldstone, Andrew B., additional, Groth, Shawn S., additional, Grover, Frederick L., additional, Guccione, Julius, additional, Ha, Richard, additional, Hammon, John W., additional, Hanna, Jennifer M., additional, Harrison, David G., additional, Hauser, Thomas H., additional, Henn, Matthew C., additional, Hirsch-Romano, Jennifer C., additional, Hoang, Chuong D., additional, Hofstetter, Wayne L., additional, Honjo, Osami, additional, Huynh, Tam T., additional, Bravo, Carlos E., additional, Iturra, Sebastian, additional, Jacobs, Jeffrey P., additional, Jacobs, Marshall L., additional, Jaklitsch, Michael T., additional, Jamieson, Stuart W., additional, Jarrar, Doraid, additional, Jarrett, Craig M., additional, Jones, David R., additional, Josephson, Mark E., additional, Joventino, Lilian P., additional, Juraszek, Amy L., additional, Kachala, Stefan S., additional, Kaiser, Larry R., additional, Kanter, Kirk R., additional, Karamichalis, John M., additional, Kaza, Aditya K., additional, Kemp, Clinton D., additional, Kernstine, Kemp H., additional, Keshavamurthy, Suresh, additional, Keshavjee, Shaf, additional, Kozik, Deborah J., additional, Laham, Roger J., additional, Landzberg, Michael J., additional, Lawrance, Christopher P., additional, Lee, Lawrence S., additional, LeMaire, Scott A., additional, Levitsky, Sidney, additional, Levy, Jerrold H., additional, Linden, Philip A., additional, Liptay, Michael J., additional, Litle, Virginia R., additional, Rito, Mauro Lo, additional, Luketich, James D., additional, Lytle, Bruce W., additional, Madani, Michael, additional, Mahmood, Feroze, additional, Mallidi, Hari R., additional, Mangi, Abeel A., additional, Manning, Warren J., additional, Marom, Edith M., additional, Marshall, Audrey C., additional, Martinez, Mauricio Perez, additional, Mascio, Christopher E., additional, Mason, David P., additional, Mathisen, Douglas J., additional, Mattox, Kenneth L., additional, Matyal, Robina, additional, McCully, James D., additional, McKenna, Robert J., additional, McNamee, Ciaran, additional, McNeil, Jeffrey D., additional, Menicanti, Lorenzo, additional, Mestres, Carlos A., additional, Mettler, Bret A., additional, Meyers, Bryan Fitch, additional, Mick, Stephanie, additional, Mihaljevic, Tomislav, additional, Milano, Carmelo A., additional, Miller, D. Craig, additional, Miller, Daniel L., additional, Miller, Meagan M., additional, Mitchell, John D., additional, Montealegre-Gallegos, Mario, additional, Moores, Neal G., additional, Murphy, Charles E., additional, Murthy, Raghav A., additional, Murthy, Sudish C., additional, Mussot, Sacha, additional, Naka, Yoshifumi, additional, Nathan, Meena, additional, Newman, Kurt D., additional, Nwogu, Chukwumere, additional, Odegard, Kirsten C., additional, Oh, Daniel S., additional, Ohye, Richard G., additional, Onaitis, Mark W., additional, Ostojic, Aleksandra, additional, Ott, Harald C., additional, Ouzounian, Maral, additional, Owais, Khurram, additional, Padalino, Massimo, additional, Papadakis, Konstantinos, additional, Patterson, G.A., additional, Patz, Edward F., additional, Paul, Subroto, additional, Pennathur, Arjun, additional, Perry, Yaron, additional, Piana, Robert N., additional, Pigula, Frank A., additional, Pinto, Duane S., additional, Pomar, Jose L., additional, Preventza, Ourania, additional, Pua, Bradley, additional, Puri, Varun, additional, Quinonez, Luis, additional, Raja, Siva, additional, Ratcliffe, Mark, additional, Reardon, Michael J., additional, Reilly, John J., additional, Reyes, Karl G., additional, Rice, Thomas W., additional, Robbins, Robert C., additional, Rocco, Gaetano, additional, Rubens, Fraser D., additional, Ruel, Marc, additional, Rusch, Valerie W., additional, Sabe, Ashraf A., additional, Said, Sameh M., additional, Samson, Pamela P., additional, Sanders, Stephen P., additional, Sarin, Eric L., additional, Schaff, Hartzell V., additional, Schaheen, Lara W., additional, Seder, Christopher W., additional, Sellke, Frank W., additional, Sepesi, Boris, additional, Shahani, Rohit, additional, Shamberger, Robert C., additional, Shapira, Oz M., additional, Shay, Steven S., additional, Shrager, Joseph B., additional, Si, Ming-Sing, additional, Singh, Steve K., additional, Smith, Peter K., additional, Sodha, Neel R., additional, Solaro, R. John, additional, Soukiasian, Harmik J., additional, Spurlock, David, additional, Stellin, Giovanni, additional, Stiles, Brendon M., additional, Straznicka, Michaela, additional, Stump, David A., additional, Sugarbaker, David J., additional, Suuronen, Erik J., additional, Svensson, Lars G., additional, Swanson, Scott J., additional, Szeto, Wilson Y., additional, Taghavi, Sharven, additional, Takayama, Hiroo, additional, Takeda, Koji, additional, Thiagarajan, Ravi R., additional, Thistlethwaite, Patricia A., additional, Thourani, Vinod H., additional, Toeg, Hadi D., additional, Tong, Michael Z., additional, Truesdell, Alexander G., additional, Tsai, Peter I., additional, Urschel, Harold C., additional, Valente, Anne Marie, additional, Vallabhajosyula, Prashanth, additional, Velotta, Jeffrey B., additional, Vida, Vladimiro, additional, Vlahakes, Gus J., additional, Voisine, Pierre, additional, Wall, Matthew J., additional, Walsh, Garrett L., additional, Walters, Dustin M., additional, Wei, Benjamin, additional, Welsby, Ian J., additional, Westfall, Margaret V., additional, Wiener, Daniel C., additional, Wilcox, Benson R., additional, Williams, Judson B., additional, Wilson, Jay M., additional, Woo, Y. Joseph, additional, Wood, Douglas E., additional, Wylie, John V., additional, Yang, Stephen C., additional, Yendamuri, Sai, additional, Yeon, Susan B., additional, and Zimetbaum, Peter J., additional

Published
2016
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194. Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery

Author

Fearon, William F., primary, Zimmermann, Frederik M., additional, De Bruyne, Bernard, additional, Piroth, Zsolt, additional, van Straten, Albert H.M., additional, Szekely, Laszlo, additional, Davidavičius, Giedrius, additional, Kalinauskas, Gintaras, additional, Mansour, Samer, additional, Kharbanda, Rajesh, additional, Östlund-Papadogeorgos, Nikolaos, additional, Aminian, Adel, additional, Oldroyd, Keith G., additional, Al-Attar, Nawwar, additional, Jagic, Nikola, additional, Dambrink, Jan-Henk E., additional, Kala, Petr, additional, Angerås, Oskar, additional, MacCarthy, Philip, additional, Wendler, Olaf, additional, Casselman, Filip, additional, Witt, Nils, additional, Mavromatis, Kreton, additional, Miner, Steven E.S., additional, Sarma, Jaydeep, additional, Engstrøm, Thomas, additional, Christiansen, Evald H., additional, Tonino, Pim A.L., additional, Reardon, Michael J., additional, Lu, Di, additional, Ding, Victoria Y., additional, Kobayashi, Yuhei, additional, Hlatky, Mark A., additional, Mahaffey, Kenneth W., additional, Desai, Manisha, additional, Woo, Y. Joseph, additional, Yeung, Alan C., additional, and Pijls, Nico H.J., additional

Published
2022
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195. Biomechanical engineering analysis of an acute papillary muscle rupture disease model using an innovative 3D-printed left heart simulator

Author

Marin-Cuartas, Mateo, primary, Zhu, Yuanjia, additional, Imbrie-Moore, Annabel M, additional, Park, Matthew H, additional, Wilkerson, Robert J, additional, Leipzig, Matthew, additional, Pandya, Pearly K, additional, Paulsen, Michael J, additional, Borger, Michael A, additional, and Woo, Y Joseph, additional

Published
2022
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197. Risk for non-home discharge following surgery for ischemic mitral valve disease

Author

Lala, Anuradha, primary, Chang, Helena L., additional, Liu, Xiaoyu, additional, Charles, Eric J., additional, Yerokun, Babatunde A., additional, Bowdish, Michael E., additional, Thourani, Vinod H., additional, Mack, Michael J., additional, Miller, Marissa A., additional, O'Gara, Patrick T., additional, Blackstone, Eugene H., additional, Moskowitz, Alan J., additional, Gelijns, Annetine C., additional, Mullen, John C., additional, Stevenson, Lynne W., additional, DeRose, Joseph J., additional, Wang, Alice, additional, Smith, Peter K., additional, Acker, Michael A., additional, Ailawadi, Gorav, additional, Taddei-Peters, Wendy C., additional, Buxton, Dennis, additional, Caulder, Ron, additional, Geller, Nancy L., additional, Gordon, David, additional, Jeffries, Neal O., additional, Lee, Albert, additional, Gombos, Ilana Kogan, additional, Ralph, Jennifer, additional, Weisel, Richard D., additional, Gardner, Timothy J., additional, Rose, Eric A., additional, Parides, Michael K., additional, Ascheim, Deborah D., additional, Bagiella, Emilia, additional, Moquete, Ellen, additional, Chang, Helena, additional, Chase, Melissa, additional, Foo, James, additional, Chen, Yingchun, additional, Goldfarb, Seth, additional, Gupta, Lopa, additional, Kirkwood, Katherine, additional, Dobrev, Edlira, additional, Levitan, Ron, additional, O'Sullivan, Karen, additional, Overbey, Jessica, additional, Santos, Milerva, additional, Williams, Deborah, additional, Weglinski, Michael, additional, Williams, Paula, additional, Wood, Carrie, additional, Ye, Xia, additional, Nielsen, Sten Lyager, additional, Wiggers, Henrik, additional, Malgaard, Henning, additional, Mack, Michael, additional, Adame, Tracine, additional, Settele, Natalie, additional, Adams, Jenny, additional, Ryan, William, additional, Smith, Robert L., additional, Grayburn, Paul, additional, Chen, Frederick Y., additional, Nohria, Anju, additional, Cohn, Lawrence, additional, Shekar, Prem, additional, Aranki, Sary, additional, Couper, Gregory, additional, Davidson, Michael, additional, Bolman, R. Morton, additional, Burgess, Anne, additional, Conboy, Debra, additional, Lawrence, Rita, additional, Noiseux, Nicolas, additional, Stevens, Louis-Mathieu, additional, Prieto, Ignacio, additional, Basile, Fadi, additional, Dionne, Joannie, additional, Fecteau, Julie, additional, Gillinov, A. Marc, additional, Lackner, Pamela, additional, Berroteran, Leoma, additional, Dolney, Diana, additional, Fleming, Suzanne, additional, Palumbo, Roberta, additional, Whitman, Christine, additional, Sankovic, Kathy, additional, Sweeney, Denise Kosty, additional, Geither, Carrie, additional, Doud, Kristen, additional, Pattakos, Gregory, additional, Clarke, Pamela A., additional, Argenziano, Michael, additional, Williams, Mathew, additional, Goldsmith, Lyn, additional, Smith, Craig R., additional, Naka, Yoshifumi, additional, Stewart, Allan, additional, Schwartz, Allan, additional, Bell, Daniel, additional, Van Patten, Danielle, additional, Sreekanth, Sowmya, additional, Alexander, John H., additional, Milano, Carmelo A., additional, Glower, Donald D., additional, Mathew, Joseph P., additional, Harrison, J. Kevin, additional, Welsh, Stacey, additional, Berry, Mark F., additional, Parsa, Cyrus J., additional, Tong, Betty C., additional, Williams, Judson B., additional, Ferguson, T. 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Published
2021
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198. Integration of Reinforcement Learning in a Virtual Robotic Surgical Simulation.

Author

Bourdillon, Alexandra T., Garg, Animesh, Wang, Hanjay, Woo, Y. Joseph, Pavone, Marco, and Boyd, Jack

Abstract

Background. The revolutions in AI hold tremendous capacity to augment human achievements in surgery, but robust integration of deep learning algorithms with high-fidelity surgical simulation remains a challenge. We present a novel application of reinforcement learning (RL) for automating surgical maneuvers in a graphical simulation. Methods. In the Unity3D game engine, the Machine Learning-Agents package was integrated with the NVIDIA FleX particle simulator for developing autonomously behaving RL-trained scissors. Proximal Policy Optimization (PPO) was used to reward movements and desired behavior such as movement along desired trajectory and optimized cutting maneuvers along the deformable tissue-like object. Constant and proportional reward functions were tested, and TensorFlow analytics was used to informed hyperparameter tuning and evaluate performance. Results. RL-trained scissors reliably manipulated the rendered tissue that was simulated with soft-tissue properties. A desirable trajectory of the autonomously behaving scissors was achieved along 1 axis. Proportional rewards performed better compared to constant rewards. Cumulative reward and PPO metrics did not consistently improve across RL-trained scissors in the setting for movement across 2 axes (horizontal and depth). Conclusion. Game engines hold promising potential for the design and implementation of RL-based solutions to simulated surgical subtasks. Task completion was sufficiently achieved in one-dimensional movement in simulations with and without tissue-rendering. Further work is needed to optimize network architecture and parameter tuning for increasing complexity. [ABSTRACT FROM AUTHOR]

Published
2023
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