210 results on '"Byrne JG"'
Search Results
2. Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery.
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Pretorius M, Murray KT, Yu C, Byrne JG, Billings FT 4th, Petracek MR, Greelish JP, Hoff SJ, Ball SK, Mishra V, Body SC, Brown NJ, Pretorius, Mias, Murray, Katherine T, Yu, Chang, Byrne, John G, Billings, Frederic T 4th, Petracek, Michael R, Greelish, James P, and Hoff, Steven J
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- 2012
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3. Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery.
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Fleming GA, Murray KT, Yu C, Byrne JG, Greelish JP, Petracek MR, Hoff SJ, Ball SK, Brown NJ, Pretorius M, Fleming, Gregory A, Murray, Katherine T, Yu, Chang, Byrne, John G, Greelish, James P, Petracek, Michael R, Hoff, Steven J, Ball, Stephen K, Brown, Nancy J, and Pretorius, Mias
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- 2008
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4. Combined percutaneous coronary intervention and valve surgery.
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Greelish JP, Ailiwadi M, Balaguer JM, Ahmad RM, Zhao DX, Petracek MR, and Byrne JG
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- 2006
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5. Atrial endocarditis-the importance of the regurgitant jet lesion.
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Gregory SA, Yepes CB, Byrne JG, D'Ambra MN, and Chen MH
- Abstract
The jet lesions of valvular regurgitation or intracardiac shunts have been hypothesized to play an important role in the pathogenesis of endocarditis for many years. We describe a case of mitral valve endocarditis that involved the left atrium along the path of a jet lesion. This resulted in atrial endocarditis and pericarditis, both of which complicated her presentation and hospital course. Using transesophageal echocardiography, we were able to directly visualize the path and full extent of infection prior to surgery. Special attention should be focused upon the path of eccentric jets in order to fully define the extent of endocarditis.(ECHOCARDIOGRAPHY, Volume 22, May 2005) [ABSTRACT FROM AUTHOR]
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- 2005
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6. Staged initial percutaneous coronary intervention followed by valve surgery ('hybrid approach') for patients with complex coronary and valve disease.
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Byrne JG, Leacche M, Unic D, Rawn JD, Simon DI, Rogers CD, and Cohn LH
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- 2005
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7. The use of cardiopulmonary bypass during resection of locally advanced thoracic malignancies: a 10-year two-center experience.
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Byrne JG, Leacche M, Agnihotri AK, Paul S, Bueno R, Mathison DJ, Sugarbaker DJ, Byrne, John G, Leacche, Marzia, Agnihotri, Arvind K, Paul, Subroto, Bueno, Raphael, Mathisen, Douglas J, and Sugarbaker, David J
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The use of cardiopulmonary bypass (CPB) for locally advanced thoracic malignancies is highly controversial. The purpose of this study was to document the techniques and results of CPB to facilitate the resection of complex thoracic malignancies and to identify common themes that provided for successful outcomes. This was a retrospective study that took place from January 1992 to September 2002. Fourteen consecutive patients (median age, 59 years; age range, 18 to 69 years; seven men and seven women) underwent CPB during the resection of locally advanced thoracic malignancies at two Boston hospitals. CPB was planned in 8 of 14 patients (57%) with centrally located tumors, while 6 of 14 patients (43%) required emergent institution of CPB due to injury of the superior vena cava (2 patients), inferior vena cava (2 patients), or pulmonary artery (2 patients). Complete microscopic resection was achieved in 12 of 14 patients (86%). The operative mortality rate was 1 of 14 patients (7%) due to pulmonary embolism (ie, the elective group). The median ICU and hospital lengths of stay were 5 and 9 days, respectively. The overall 1-year, 3-year, and 5-year survival rates were 57%, 36%, and 21%, respectively. The planned use of CPB to facilitate complete resection of thoracic malignancies should be considered only after careful patient selection. The availability of CPB also provides a safety net in the event of injury to vascular structures during tumor resection. [ABSTRACT FROM AUTHOR]
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- 2004
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8. Valve surgery in octogenarians with a "porcelain" aorta and aortic insufficiency.
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Greelish JP, Soltesz EG, Byrne JG, Greelish, James P, Soltesz, Edward G, and Byrne, John G
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- 2002
9. Mitral valve repair in redo cardiac surgery.
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Adams DH, Filsoufi F, Byrne JG, Karavas AN, Aklog L, Adams, D H, Filsoufi, F, Byrne, J G, Karavas, A N, and Aklog, L
- Published
- 2002
10. Minimally invasive direct access heart valve surgery.
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Byrne JG, Hsin MK, Adams DH, Aklog L, Aranki SF, Couper GS, Rizzo RJ, Cohn LH, Byrne, J G, Hsin, M K, Adams, D H, Aklog, L, Aranki, S F, Couper, G S, Rizzo, R J, and Cohn, L H
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- 2000
11. Repair versus replacement of mitral valve for treating severe ischemic mitral regurgitation.
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Byrne JG, Aranki SF, Cohn LH, Byrne, J G, Aranki, S F, and Cohn, L H
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- 2000
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12. Combination TMR and gene therapy
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Sayeed-Shah, U, Reul, RM, Byrne, JG, Aranki, SF, and Cohn, LH
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- 1999
13. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine.
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB Jr, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JW, Oliver-McNeil SM, Popma JJ, Tommaso CL, Bashore, Thomas M, Balter, Stephen, and Barac, Ana
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- 2012
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14. Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.
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Zhao DX, Leacche M, Balaguer JM, Boudoulas KD, Damp JA, Greelish JP, Byrne JG, Ahmad RM, Ball SK, Cleator JH, Deegan RJ, Eagle SS, Fong PP, Fredi JL, Hoff SJ, Jennings HS 3rd, McPherson JA, Piana RN, Pretorius M, and Robbins MA
- Abstract
Objectives: This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room.Background: The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved.Methods: Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n = 112) or without (n = 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings.Results: Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n = 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n = 48, 6%) or with traditional surgical revision (n = 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients.Conclusions: Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease. [ABSTRACT FROM AUTHOR]- Published
- 2009
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15. Early and late results of isolated and combined heart valve surgery in patients > or =80 years of age.
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Unic D, Leacche M, Paul S, Rawn JD, Aranki SF, Couper GS, Mihaljevic T, Rizzo RJ, Cohn LH, O'Gara PT, Byrne JG, Unic, Daniel, Leacche, Marzia, Paul, Subroto, Rawn, James D, Aranki, Sary F, Couper, Gregory S, Mihaljevic, Tomislav, Rizzo, Robert J, and Cohn, Lawrence H
- Abstract
We present a series of 405 consecutive patients aged > or =80 years who underwent isolated or combined valve surgery over a 5-year period. Our results demonstrate that valve surgery in the elderly can be performed with acceptable early mortality, good late survival, and excellent late functional outcome. [ABSTRACT FROM AUTHOR]
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- 2005
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16. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons.
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM Jr, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, and Selnes O
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- 2011
17. Breaking the ESG rating divergence: An open geospatial framework for environmental scores.
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Rossi C, Byrne JG, and Christiaen C
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- Humans, Data Collection, Dehydration, Dissent and Disputes, Biodiversity, Climate Change
- Abstract
Information about a company's environmental, social and governance (ESG) performance has become increasingly important in the decision-making process of financial institutions. The financial implications of environmental challenges (e.g. water stress), negative social impacts (e.g. health impacts in local communities) or poor corporate governance (e.g. breaching legislation) all continue to increase. Accordingly, there is a need for financial institutions to incorporate information on ESG risks, opportunities and impacts in decisions that relate to risk management, investments, credit, strategy, and reporting. ESG information is typically disseminated through ESG ratings, which combine the three constituents into a single rating, or ascribe them separate scores. The compilation of ESG ratings and the identification of appropriate data sources is an inherently complex process; as such, there is no single standard for data collection or reporting. This has led to a divergence in the underlying data sources used by different rating providers, as well as in the determination of factors that are deemed worthy of measurement in the first place. For example, when assessing a company's environmental impact, one rating provider may rely on company-provided data, while another may incorporate independent third-party assessments. Unfortunately, there is currently no clear mechanism for effectively resolving such disagreements to establish a standardised approach to ESG rating assessments. However, geospatial data and analyses offer several key advantages for ESG assessments, including consistency, the potential for enhanced accuracy, and the ability to identify and assess environmental impacts at a detailed physical asset level, in addition to evaluating the broader spatial context. By incorporating geospatial information (obtained through manually processing remotely sensed data, or by using existing products) rating methodologies can be improved, and disparities can be addressed more effectively. This would enable a more comprehensive understanding of the environmental considerations of ESG assessments, promoting a more informed and precise decision-making process. Within this context, a few institutions (e.g. the University of Oxford, the WWF, and a few others) are pioneering thought leadership around spatial finance, including the assessment of ESG issues utilising geospatial intelligence, but there are no consistent frameworks for incorporating geospatial data into ESG ratings and analysis. This paper explores the opportunity for such a geospatial environmental scoring framework, defining a variety of methods in which open data with broad geographic coverage could be incorporated into ESG analysis, generalisable to a range of assets and sectors. The proposed framework is organised into two categories: localised effects, which directly impact the immediate vicinity of an asset, and delocalised effects, which contribute to global climate change and atmospheric pollution. Sub-scores are defined within these categories, which capture both the localised effects on land use, biodiversity, soils, and hydrology, and the global impacts resulting from atmospheric emissions. The approaches for handling geospatial data to generate both these sub-scores and the final E-score are presented, including a test case, and the complete methodology is made available in open repositories., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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18. Technique for Salvage Reconstruction of Shredded Left Main Coronary Artery After Rotablator Injury.
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Mouchli AY, Chaugle H, and Byrne JG
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- Humans, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Coronary Angiography, Coronary Artery Disease surgery, Atherectomy, Coronary methods
- Abstract
We report the technique needed to effectively repair a left main coronary artery shredding after rotational atherectomy and destruction of the left main coronary artery. The patient had been deemed inoperable at another center because of diffuse distal coronary disease. The complication led to cardiac tamponade and hemodynamic collapse, necessitating cardiopulmonary resuscitation and salvage surgery. This is perhaps the first case in the literature to show a successful repair of such a complex and significant left main, left anterior descending, and left circumflex coronary artery rupture in a patient in extremis., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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19. Altered ADAMTS5 Expression and Versican Proteolysis: A Possible Molecular Mechanism in Barlow's Disease.
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Absi TS, Galindo CL, Gumina RJ, Atkinson J, Guo Y, Tomasek K, Sawyer DB, Byrne JG, Kaiser CA, Shah AS, Su YR, and Petracek M
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- ADAMTS5 Protein metabolism, Adult, Aged, Case-Control Studies, Female, Humans, Male, Microarray Analysis, Middle Aged, Mitral Valve Insufficiency metabolism, Mitral Valve Insufficiency pathology, Mitral Valve Prolapse metabolism, Mitral Valve Prolapse pathology, Proteolysis, Reverse Transcriptase Polymerase Chain Reaction, Transcriptome, ADAMTS5 Protein genetics, Mitral Valve Insufficiency genetics, Mitral Valve Prolapse genetics, Versicans metabolism
- Abstract
Background: We hypothesized that gene expression profiles of mitral valve (MV) leaflets from patients with Barlow's disease (BD) are distinct from those with fibroelastic deficiency (FED)., Methods: MVs were obtained from patients with BD (7 men, 3 women; 61.4 ± 12.7 years old) or FED (6 men, 5 women; 54.5 ± 6.0 years old) undergoing operations for severe mitral regurgitation (MR). Normal MVs were obtained from 6 donor hearts unmatched for transplant (3 men, 3 women; 58.3 ± 7.5 years old), and gene expression was assessed using cDNA microarrays. Select transcripts were validated by quantitative reverse-transcription polymerase chain reaction, followed by an assessment of protein levels by immunostaining., Results: The global gene expression profile for BD was clearly distinct from normal and FED groups. A total of 4,684 genes were significantly differential (fold-difference >1.5, p < 0.05) among the three groups, 1,363 of which were commonly altered in BD and FED compared with healthy individuals (eg TGFβ2 [transforming growth factor β2] and TGFβ3 were equally upregulated in BD and FED). Most interesting were 329 BD-specific genes, including ADAMTS5 (a disintegrin-like and metalloprotease domain with thrombospondin-type 5), which was uniquely downregulated in BD based on microarrays and quantitative reverse-transcription polymerase chain reaction. Consistent with this finding, the ADAMTS5 substrate versican was increased in BD and conversely lower in FED., Conclusions: MV leaflets in BD and FED exhibit distinct gene expression patterns, suggesting different pathophysiologic mechanisms are involved in leaflet remodeling. Moreover, downregulation of ADAMTS5 in BD, along with the accumulation of its substrate versican in the valvular extracellular matrix, might contribute to leaflet thickening and enlargement., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2018
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20. Off-Pump CABG Surgery "No-Touch" Technique to Reduce Adverse Neurological Outcomes.
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Byrne JG and Leacche M
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- Aorta, Network Meta-Analysis, Coronary Artery Bypass, Coronary Artery Bypass, Off-Pump
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- 2017
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21. Surgical outcomes of infective endocarditis among intravenous drug users.
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Kim JB, Ejiofor JI, Yammine M, Ando M, Camuso JM, Youngster I, Nelson SB, Kim AY, Melnitchouk SI, Rawn JD, MacGillivray TE, Cohn LH, Byrne JG, and Sundt TM 3rd
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- Adult, Endocarditis mortality, Female, Humans, Male, Middle Aged, Postoperative Complications, Propensity Score, Prospective Studies, Recurrence, Risk Factors, Treatment Outcome, Endocarditis surgery, Substance Abuse, Intravenous complications
- Abstract
Background: With increasing prevalence of injected drug use in the United States, a growing number of intravenous drug users (IVDUs) are at risk for infective endocarditis (IE) that may require surgical intervention; however, few data exist about clinical outcomes of these individuals., Methods: We evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from 2 prospective institutional databases. Death and valve-related events, including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated., Results: Of the 436 patients identified, 78 (17.9%) were current IVDUs. The proportion of IVDUs increased from 14.8% in 2002 to 2004 to 26.1% in 2012 to 2014. IVDUs were younger (aged 35.9 ± 9.9 years vs 59.3 ± 14.1 years) and had fewer cardiovascular risk factors than non-IVDUs. During follow-up (median, 29.4 months; quartile 1-3, 4.7-72.6 months), adverse events among all patients included death in 92, reinfection in 42, valve-reoperation in 35, thromboembolism in 17, and hemorrhage in 16. Operative mortality was lower among IVDUs (odds ratio, 0.25; 95% confidence interval [CI], 0.06-0.71), but overall mortality was not significantly different (hazard ratio [HR], 0.78; 95% CI, 0.44-1.37). When baseline profiles were adjusted by propensity score, IVDUs had higher risk of valve-related complications (HR, 3.82; 95% CI, 1.95-7.49; P < .001) principally attributable to higher rates of reinfection (HR, 6.20; 95% CI, 2.56-15.00; P < .001)., Conclusions: The proportion of IVDUs among surgically treated IE patients is increasing. Although IVDUs have lower operative risk, long-term outcomes are compromised by reinfection., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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22. Are homografts superior to conventional prosthetic valves in the setting of infective endocarditis involving the aortic valve?
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Kim JB, Ejiofor JI, Yammine M, Camuso JM, Walsh CW, Ando M, Melnitchouk SI, Rawn JD, Leacche M, MacGillivray TE, Cohn LH, Byrne JG, and Sundt TM
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- Academic Medical Centers, Adult, Aged, Aortic Valve pathology, Databases, Factual, Endocarditis diagnostic imaging, Endocarditis microbiology, Endocarditis mortality, Female, Graft Rejection, Graft Survival, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Humans, Male, Middle Aged, Multivariate Analysis, Postoperative Complications epidemiology, Postoperative Complications physiopathology, Prognosis, Proportional Hazards Models, Prosthesis-Related Infections diagnosis, Prosthesis-Related Infections epidemiology, Retrospective Studies, Risk Assessment, Survival Analysis, Treatment Outcome, Ultrasonography, United States, Allografts, Aortic Valve surgery, Bioprosthesis, Endocarditis surgery, Heterografts, Prosthesis Failure
- Abstract
Background: Surgical dogma suggests that homografts should be used preferentially, compared with conventional xenograft or mechanical prostheses, in the setting of infective endocarditis (IE), because they have greater resistance to infection. However, comparative data that support this notion are limited., Methods: From the prospective databases of 2 tertiary academic centers, we identified 304 consecutive adult patients (age ≥17 years) who underwent surgery for active IE involving the aortic valve (AV), in the period 2002 to 2014. Short- and long-term outcomes were evaluated using propensity scores and inverse-probability weighting to adjust for selection bias., Results: Homografts, and xenograft and mechanical prostheses, were used in 86 (28.3%), 139 (45.7%), and 79 (26.0%) patients, respectively. Homografts were more often used in the setting of prosthetic valve endocarditis (58.1% vs 28.8%, P = .002) and methicillin-resistant Staphylococcus (25.6% vs 12.1%, P = .002), compared with conventional prostheses. Early mortality occurred in 17 (19.8%) in the homograft group, and 20 (9.2%) in the conventional group (P = .019). During follow-up (median: 29.4 months; interquartile-range: 4.7-72.6 months), 60 (19.7%) patients died, and 23 (7.7%) experienced reinfection, with no significant differences in survival (P = .23) or freedom from reinfection rates (P = .65) according to the types of prostheses implanted. After adjustments for baseline characteristics, using propensity-score analyses, use of a homograft did not significantly affect early death (odds ratio 1.61; 95% confidence interval [CI], 0.73-3.40, P = .23), overall death (hazard ratio 1.10; 95% CI, 0.62-1.94, P = .75), or reinfection (hazard ratio 1.04; 95% CI, 0.49-2.18, P = .93)., Conclusions: No significant benefit to use of homografts was demonstrable with regard to resistance to reinfection in the setting of IE. The choice among prosthetic options should be based on technical and patient-specific factors. Lack of availability of homografts should not impede appropriate surgical intervention., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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23. High-Dose Perioperative Atorvastatin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial.
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Billings FT 4th, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Byrne JG, and Brown NJ
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- Acute Kidney Injury blood, Acute Kidney Injury etiology, Aged, Aged, 80 and over, Aspartate Aminotransferases blood, Atorvastatin adverse effects, Creatinine blood, Double-Blind Method, Drug Administration Schedule, Female, Glomerular Filtration Rate, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects, Male, Medication Adherence statistics & numerical data, Middle Aged, Postoperative Complications, Renal Insufficiency, Chronic complications, Acute Kidney Injury prevention & control, Atorvastatin administration & dosage, Cardiac Surgical Procedures adverse effects, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage
- Abstract
Importance: Statins affect several mechanisms underlying acute kidney injury (AKI)., Objective: To test the hypothesis that short-term high-dose perioperative atorvastatin would reduce AKI following cardiac surgery., Design, Setting, and Participants: Double-blinded, placebo-controlled, randomized clinical trial of adult cardiac surgery patients conducted from November 2009 to October 2014 at Vanderbilt University Medical Center., Interventions: Patients naive to statin treatment (n = 199) were randomly assigned 80 mg of atorvastatin the day before surgery, 40 mg of atorvastatin the morning of surgery, and 40 mg of atorvastatin daily following surgery (n = 102) or matching placebo (n = 97). Patients already taking a statin prior to study enrollment (n = 416) continued taking the preenrollment statin until the day of surgery, were randomly assigned 80 mg of atorvastatin the morning of surgery and 40 mg of atorvastatin the morning after (n = 206) or matching placebo (n = 210), and resumed taking the previously prescribed statin on postoperative day 2., Main Outcomes and Measures: Acute kidney injury defined as an increase of 0.3 mg/dL in serum creatinine concentration within 48 hours of surgery (Acute Kidney Injury Network criteria)., Results: The data and safety monitoring board recommended stopping the group naive to statin treatment due to increased AKI among these participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) receiving atorvastatin. The board later recommended stopping for futility after 615 participants (median age, 67 years; 188 [30.6%] were women; 202 [32.8%] had diabetes) completed the study. Among all participants (n = 615), AKI occurred in 64 of 308 (20.8%) in the atorvastatin group vs 60 of 307 (19.5%) in the placebo group (relative risk [RR], 1.06 [95% CI, 0.78 to 1.46]; P = .75). Among patients naive to statin treatment (n = 199), AKI occurred in 22 of 102 (21.6%) in the atorvastatin group vs 13 of 97 (13.4%) in the placebo group (RR, 1.61 [0.86 to 3.01]; P = .15) and serum creatinine concentration increased by a median of 0.11 mg/dL (10th-90th percentile, -0.11 to 0.56 mg/dL) in the atorvastatin group vs by a median of 0.05 mg/dL (10th-90th percentile, -0.12 to 0.33 mg/dL) in the placebo group (mean difference, 0.08 mg/dL [95% CI, 0.01 to 0.15 mg/dL]; P = .007). Among patients already taking a statin (n = 416), AKI occurred in 42 of 206 (20.4%) in the atorvastatin group vs 47 of 210 (22.4%) in the placebo group (RR, 0.91 [0.63 to 1.32]; P = .63)., Conclusions and Relevance: Among patients undergoing cardiac surgery, high-dose perioperative atorvastatin treatment compared with placebo did not reduce the risk of AKI overall, among patients naive to treatment with statins, or in patients already taking a statin. These results do not support the initiation of statin therapy to prevent AKI following cardiac surgery., Trial Registration: clinicaltrials.gov Identifier: NCT00791648.
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- 2016
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24. No Right Answer.
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Poterucha T, Vedula R, Kapur S, Christopher KB, Byrne JG, and Adler D
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- Endocarditis therapy, Humans, Male, Middle Aged, Pulmonary Valve Insufficiency therapy, Endocarditis complications, Endocarditis diagnosis, Pulmonary Valve Insufficiency complications, Pulmonary Valve Insufficiency diagnosis
- Published
- 2015
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25. Robotic CABG and Hybrid Approaches: The Current Landscape.
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Ejiofor JI, Leacche M, and Byrne JG
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- Combined Modality Therapy, Coronary Artery Bypass adverse effects, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Humans, Patient Selection, Percutaneous Coronary Intervention adverse effects, Risk Assessment, Risk Factors, Robotic Surgical Procedures adverse effects, Treatment Outcome, Coronary Artery Bypass methods, Coronary Artery Disease therapy, Percutaneous Coronary Intervention methods, Robotic Surgical Procedures methods
- Abstract
Modern treatment of coronary artery disease (CAD) requires a patient-centered approach. With several technological advances, the options for treatment must be carefully weighed and novel approaches tested for safety and efficacy. In this chapter, we outline some of the new approaches available to cardiac surgeons for the treatment of CAD, including off pump coronary artery bypass grafting, minimally invasive as well as hybrid and robotic coronary revascularization. We discuss current evidence and controversies, and highlight the future directions and challenges in the field of surgical coronary revascularization., (Copyright © 2015. Published by Elsevier Inc.)
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- 2015
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26. Influence of experience and the surgical learning curve on long-term patient outcomes in cardiac surgery.
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Burt BM, ElBardissi AW, Huckman RS, Cohn LH, Cevasco MW, Rawn JD, Aranki SF, and Byrne JG
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- Aged, Aged, 80 and over, Cardiopulmonary Bypass education, Coronary Artery Bypass adverse effects, Coronary Artery Bypass mortality, Databases, Factual, Efficiency, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Humans, Linear Models, Logistic Models, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Quality Indicators, Health Care, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Clinical Competence, Coronary Artery Bypass education, Education, Medical, Graduate methods, Heart Valve Prosthesis Implantation education, Learning Curve
- Abstract
Objective: We hypothesized that increased postgraduate surgical experience correlates with improved operative efficiency and long-term survival in standard cardiac surgery procedures., Methods: Utilizing a prospectively collected retrospective database, we identified patients who underwent isolated coronary artery bypass grafting (CABG) (n = 3726), aortic valve replacement (AVR) (n = 1626), mitral valve repair (n = 731), mitral valve replacement (MVR) (n = 324), and MVR + AVR (n = 184) from January 2002 through June 2012. After adjusting for patient risk and surgeon variability, we evaluated the influence of surgeon experience on cardiopulmonary bypass and crossclamp times, and long-term survival., Results: Mean surgeon experience after fellowship graduation was 16.0 ± 11.7 years (range, 1.0-35.2 years). After adjusting for patient risk and surgeon-level fixed effects, learning curve analyses demonstrated improvements in cardiopulmonary bypass and crossclamp times with increased surgeon experience. There was marginal improvement in the predictability (R(2) value) of cardiopulmonary bypass and crossclamp time for CABG with the addition of surgeon experience; however, all other procedures had marked increases in the R(2) following addition of surgeon experience. Cox proportional hazard models revealed that increased surgeon experience was associated with improved long-term survival in AVR (hazard ratio [HR], 0.85; P < .0001), mitral valve repair (HR, 0.73; P < .0001), and MVR + AVR (HR, 0.95; P = .006) but not in CABG (HR, 0.80; P = .15), and a trend toward significance in MVR (HR, 0.87; P = .09)., Conclusions: In cardiac surgery, not including CABG, surgeon experience is an important determinant of operative efficiency and of long-term survival., (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2015
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27. Surgical Embolectomy for Acute Massive and Submassive Pulmonary Embolism in a Series of 115 Patients.
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Neely RC, Byrne JG, Gosev I, Cohn LH, Javed Q, Rawn JD, Goldhaber SZ, Piazza G, Aranki SF, Shekar PS, and Leacche M
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- Aged, Contraindications, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications epidemiology, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism drug therapy, Pulmonary Embolism mortality, Pulmonary Embolism physiopathology, Retrospective Studies, Risk Factors, Thrombolytic Therapy, Tomography, X-Ray Computed, Treatment Outcome, Embolectomy adverse effects, Pulmonary Embolism surgery
- Abstract
Background: Pulmonary embolectomy is often indicated for central pulmonary embolism (PE) with hemodynamic instability, but remains controversial for hemodynamically stable patients with signs of right ventricular dysfunction. Because thrombolytic therapy is often contraindicated postoperatively, we reviewed risk factors and outcomes of pulmonary embolectomy for stable and unstable central PE, particularly in the early postoperative period., Methods: Between October 1999 and September 2013, 115 patients underwent pulmonary embolectomy for central, hemodynamically unstable PE (49 of 115, 43%) or hemodynamically stable PE (56 of 115, 49%). Ten operations for alternate indications (right atrial mass, endocarditis) were excluded for comparison analysis, leaving 105 patients., Results: Mean age was 59 ± 13 years; 46 of 105 patients (44%) had recent surgery (within 5 weeks): orthopedic (12 of 46, 25%), neurosurgery (11 of 46, 24%), or general surgery (10 of 46, 22%). Preoperative demographics did not differ between groups, except for the frequency of cardiopulmonary resuscitation among unstable patients (11 of 49, 22%) versus stable patients (0 of 56, 0%; p < 0.001). Operative mortality for the combined groups was 6.6% (7 of 105): unstable 10.2% (5 of 49) versus stable 3.6% (2 of 56; p = 0.247). Of 11 patients requiring preoperative cardiopulmonary resuscitation, 4 died. Six-month, 1-year, and 3-year survival rates were, respectively, 75%, 68.4%, and 65.8% for unstable PE, and 92.6%, 86.7%, and 80.4% for stable PE (p = 0.018)., Conclusions: This large series of pulmonary embolectomies demonstrates excellent early and late survival rates for patients with stable PE and unstable PE. These findings confirm pulmonary embolectomy as a beneficial therapeutic option for central PE, especially during the postoperative period when thrombolytic therapy is often contraindicated., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2015
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28. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
- Author
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, and Shen WK
- Subjects
- Humans, Predictive Value of Tests, Treatment Outcome, Cardiology standards, Diagnostic Imaging standards, Heart Function Tests standards, Myocardial Ischemia diagnosis, Myocardial Ischemia therapy
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- 2015
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29. The safety of deep hypothermic circulatory arrest in aortic valve replacement with unclampable aorta in non-octogenarians.
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Kaneko T, Neely RC, Shekar P, Javed Q, Asghar A, McGurk S, Gosev I, Byrne JG, Cohn LH, and Aranki SF
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- Age Factors, Aged, Aged, 80 and over, Aortic Diseases diagnosis, Aortic Diseases mortality, Atherosclerosis diagnosis, Atherosclerosis mortality, Boston, Circulatory Arrest, Deep Hypothermia Induced mortality, Female, Heart Valve Diseases complications, Heart Valve Diseases diagnosis, Heart Valve Diseases mortality, Heart Valve Prosthesis Implantation mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications mortality, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Vascular Calcification diagnosis, Vascular Calcification mortality, Aortic Diseases complications, Atherosclerosis complications, Circulatory Arrest, Deep Hypothermia Induced adverse effects, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation adverse effects, Vascular Calcification complications
- Abstract
Objectives: Aortic valve replacement (AVR) in patients with severely atherosclerotic aortas (porcelain aorta) presents a significant technical challenge. Two strategies are deep hypothermic circulatory arrest (DHCA) during conventional surgery and transcatheter aortic valve replacement (TAVR). The aim of this study was to examine the outcomes in patients who underwent DHCA for AVR with a porcelain aorta to identify whether older patients are more suitable for TAVR., Methods: Between October 2004 and December 2012, 122 patients underwent AVR using DHCA for atherosclerotic aorta. Patients with concomitant valve surgery were excluded. Overall, 63.9% (78/122) were of age <80 (non-octogenarian group, NOG) and 36.1% (44/122) were >80 (octogenarian group, OG). Of the total cohort, 62.3% (76/122) had concomitant coronary artery bypass graft surgery., Results: The mean age for the whole cohort was 75.7 ± 8.5 years; 70.2 ± 8.1 years for the NOG and 83.4 ± 2.6 years for the OG (P = 0.001). The OG had a higher rate of preoperative renal failure (20.5%, 9/44 vs 7.7%, 6/78, P = 0.048) and trends towards a greater history of cerebrovascular disease (9.1%, 4/44 vs 1.3%, 1/78, P = 0.056), but fewer reoperations (6.8%, 3/44 vs 19.2%, 15/78, P = 0.069). Cardiopulmonary bypass time, aortic cross-clamp time and circulatory arrest time were similar between the two groups. Postoperative complication rates were similar except for permanent stroke (OG 18.2%, 8/44 vs NOG 6.4%, 5/78, P = 0.065). The overall operative mortality rate was 8.2% (10/122); however, the OG had significantly higher operative mortality compared with the NOG (15.9%, 7/44 vs 3.8%, 3/78, P = 0.035). One- and 5-year survival rates were 88.9 and 79.3% for the NOG versus 75.0 and 65.9% for the OG (P = 0.027), respectively., Conclusions: Postoperative neurological events and operative mortality were, respectively, 3- and 4-fold higher in octogenarians undergoing AVR using DHCA. Such patients may represent suitable candidates for TAVR if favourable outcomes are demonstrated in patients with atherosclerotic aortas. Surgical AVR remains the standard treatment option with excellent outcomes for patients <80 years old with unclampable aortas., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2015
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30. Hypertension is associated with preamyloid oligomers in human atrium: a missing link in atrial pathophysiology?
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Sidorova TN, Mace LC, Wells KS, Yermalitskaya LV, Su PF, Shyr Y, Atkinson JB, Fogo AB, Prinsen JK, Byrne JG, Petracek MR, Greelish JP, Hoff SJ, Ball SK, Glabe CG, Brown NJ, Barnett JV, and Murray KT
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- Aged, Atrial Natriuretic Factor analysis, Female, Fibrosis, Heart Atria pathology, Heart Atria physiopathology, Humans, Hypertension pathology, Hypertension physiopathology, Immunohistochemistry, Male, Middle Aged, Prealbumin analysis, Protein Aggregates, Randomized Controlled Trials as Topic, Amyloid beta-Protein Precursor analysis, Atrial Function, Heart Atria chemistry, Hypertension metabolism
- Abstract
Background: Increasing evidence indicates that proteotoxicity plays a pathophysiologic role in experimental and human cardiomyopathy. In organ-specific amyloidoses, soluble protein oligomers are the primary cytotoxic species in the process of protein aggregation. While isolated atrial amyloidosis can develop with aging, the presence of preamyloid oligomers (PAOs) in atrial tissue has not been previously investigated., Methods and Results: Atrial samples were collected during elective cardiac surgery in patients without a history of atrial arrhythmias, congestive heart failure, cardiomyopathy, or amyloidosis. Immunohistochemistry was performed for PAOs using a conformation-specific antibody, as well as for candidate proteins identified previously in isolated atrial amyloidosis. Using a myocardium-specific marker, the fraction of myocardium colocalizing with PAOs (PAO burden) was quantified (green/red ratio). Atrial samples were obtained from 92 patients, with a mean age of 61.7±13.8 years. Most patients (62%) were male, 23% had diabetes, 72% had hypertension, and 42% had coronary artery disease. A majority (n=62) underwent aortic valve replacement, with fewer undergoing coronary artery bypass grafting (n=34) or mitral valve replacement/repair (n=24). Immunostaining detected intracellular PAOs in a majority of atrial samples, with a heterogeneous distribution throughout the myocardium. Mean green/red ratio value for the samples was 0.11±0.1 (range 0.03 to 0.77), with a value ≥0.05 in 74 patients. Atrial natriuretic peptide colocalized with PAOs in myocardium, whereas transthyretin was located in the interstitium. Adjusting for multiple covariates, PAO burden was independently associated with the presence of hypertension., Conclusion: PAOs are frequently detected in human atrium, where their presence is associated with clinical hypertension., (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
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- 2014
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31. Early structural valve deterioration of the mitroflow aortic bioprosthesis.
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Kaneko T, Gosev I, Leacche M, and Byrne JG
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- Animals, Female, Humans, Male, Aortic Valve Stenosis mortality, Aortic Valve Stenosis surgery, Bioprosthesis statistics & numerical data, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation mortality
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- 2014
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32. New approaches to cardiovascular surgery.
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Neely RC, Leacche M, Byrne CR, Norman AV, and Byrne JG
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- Coronary Artery Bypass, Off-Pump methods, Coronary Artery Bypass, Off-Pump trends, Education, Medical, Graduate methods, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation trends, Humans, Robotic Surgical Procedures methods, Robotic Surgical Procedures trends, Thoracic Surgical Procedures education, Thoracic Surgical Procedures methods, Cardiovascular Diseases surgery, Thoracic Surgical Procedures trends
- Abstract
Modern treatment of cardiovascular disease requires a patient-centered approach. With several technological advances, the options for treatment must be carefully weighed and novel approaches tested for safety and efficacy. In this article, we outline some of the new approaches available to cardiothoracic surgeons for the treatment of cardiovascular diseases, including off-pump coronary artery bypass grafting, transcatheter valve replacement, and hybrid and robotic technology. We discuss current evidence and controversies and highlight the challenges that we face in training surgeons in an environment of ever-evolving surgical techniques., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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33. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
- Author
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, and Smith PK
- Subjects
- Cardiac Catheterization standards, Coronary Angiography standards, Humans, Percutaneous Coronary Intervention standards, United States, American Heart Association, Angina, Stable diagnosis, Angina, Stable therapy, Cardiology standards, Myocardial Ischemia diagnosis, Myocardial Ischemia therapy
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- 2014
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34. Minimally invasive fibrillating mitral valve replacement for patients with advanced cardiomyopathy: a safe and effective approach to treat a complex problem.
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Brittain EL, Goyal SK, Sample MA, Leacche M, Absi TS, Papa F, Churchwell KB, Ball S, Byrne JG, Maltais S, Petracek MR, and Mendes L
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- Aged, Cardiomyopathies diagnosis, Cardiomyopathies mortality, Cardiomyopathies physiopathology, Disease-Free Survival, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Minimally Invasive Surgical Procedures, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Postoperative Complications mortality, Postoperative Complications physiopathology, Postoperative Complications therapy, Recurrence, Risk Factors, Severity of Illness Index, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Right, Ventricular Pressure, Ventricular Remodeling, Cardiomyopathies complications, Heart Valve Prosthesis Implantation methods, Mitral Valve surgery, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency surgery, Ventricular Dysfunction, Left etiology, Ventricular Function, Left
- Abstract
Objective: The optimal management of mitral regurgitation (MR) in patients with cardiomyopathy has been controversial. Minimally invasive fibrillating mitral valve replacement (mini-MVR) might limit postoperative morbidity and mortality by minimizing recurrent MR. We hypothesized that mini-MVR with complete chordal sparing would offer low mortality and halt left ventricular (LV) remodeling in patients with severe cardiomyopathy and severe MR., Methods: From January 2006 to August 2009, 65 patients with an LV ejection fraction (LVEF) of ≤35% underwent mini-MVR. The demographic, echocardiographic, and clinical outcomes were analyzed., Results: The operative mortality compared with the Society of Thoracic Surgeons-predicted mortality was 6.2% versus 6.6%. It was 5.6% versus 7.4% for patients with an LVEF of ≤20% and 8.3% versus 17.9% among patients with a Society of Thoracic Surgeons-predicted mortality of ≥10%. At a median follow-up of 17 months, no recurrent MR or change in the LV dimensions or LVEF had developed, but the right ventricular systolic pressure had decreased (P=.02). At the first postoperative visit and latest follow-up visit, the New York Heart Association class had decreased from 3.0±0.6 to 1.7±0.7 and 2.0±1.0, respectively (P<.0001 for both). Patients with an LVEF of ≤20% and LV end-diastolic diameter of ≥6.5 cm were more likely to meet a composite of death, transplantation, or LV assist device insertion (P=.046)., Conclusions: Our results have shown that mini-MVR is safe in patients with advanced cardiomyopathy and resulted in no recurrent MR, stabilization of the LVEF and LV dimensions, and a decrease in right ventricular systolic pressure. This mini-MVR technique can be used to address severe MR in patients with advanced cardiomyopathy., (Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2014
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35. Suture technique does not affect hemodynamic performance of the small supra-annular Trifecta bioprosthesis.
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Ugur M, Byrne JG, Bavaria JE, Cheung A, Petracek M, Groh MA, Suri RM, Borger MA, and Schaff HV
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- Aged, Aortic Valve diagnostic imaging, Aortic Valve pathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis pathology, Echocardiography, Doppler, Female, Hemodynamics, Humans, Male, Prospective Studies, Prosthesis Design, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods, Suture Techniques
- Abstract
Objective: The study objective was to evaluate whether aortic valve replacement with the Trifecta valve (St Jude Medical Inc, St Paul, Minn) using simple sutures produces better hemodynamic performance than valve replacement with noneverting pledget-reinforced sutures., Methods: We analyzed prospectively acquired 1-year hemodynamic data of patients with small aortic annulus sizes who were enrolled in a multicenter trial of the Trifecta aortic valve bioprosthesis and underwent aortic valve replacement with a 19-mm or 21-mm bioprosthesis between August 2007 and November 2009. We compared preoperative clinical information and 1-year postoperative hemodynamic data for noneverting pledget-reinforced sutures (group 1) versus everting mattress sutures or simple sutures (group 2)., Results: A total of 346 patients underwent aortic valve replacement: 269 in group 1 and 77 in group 2. Preoperative demographic characteristics for the 2 groups were similar. For groups 1 and 2, the mean gradient was 10.4±4.7 mm Hg and 11.1±4.4 mm Hg for 19-mm valves, respectively, and 8.4±3.5 mm Hg and 8.8±3.6 mm Hg for 21-mm valves, respectively; the effective orifice area was 1.40 cm2 and 1.25 cm2 for 19-mm valves, respectively, and 1.57 cm2 and 1.50 cm2 for 21-mm valves, respectively. The rate of severe prosthesis-patient mismatch (indexed effective orifice area≤0.65 cm2/m2) was 18.6% (n=11) and 25% (n=6) for 19-mm valves, respectively, and 10.9% (n=20) and 16.3% (n=8) for 21-mm valves, respectively., Conclusions: The suture method did not affect hemodynamic performance of supra-annular bioprostheses in patients with small aortic annulus sizes. Choice of suture technique should be determined by surgeon experience and local anatomic features., (Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2014
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36. The 2014 American Heart Association/American College of Cardiology guideline for the management of patients with valvular heart disease: a changing landscape.
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Neely RC, Leacche M, Gosev I, Kaneko T, Byrne JG, and Davidson MJ
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- Humans, Cardiac Catheterization, Cardiology standards, Cardiovascular Agents therapeutic use, Exercise Test, Heart Valve Diseases diagnosis, Heart Valve Diseases therapy, Heart Valve Prosthesis Implantation, Rheumatic Fever prevention & control
- Published
- 2014
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37. Quantitative Imaging of Preamyloid Oligomers, a Novel Structural Abnormality, in Human Atrial Samples.
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Sidorova TN, Mace LC, Wells KS, Yermalitskaya LV, Su PF, Shyr Y, Byrne JG, Petracek MR, Greelish JP, Hoff SJ, Ball SK, Glabe CG, Brown NJ, Barnett JV, and Murray KT
- Subjects
- Heart diagnostic imaging, Humans, Immunohistochemistry, Microscopy, Confocal, Amyloid analysis, Heart Atria chemistry, Myocardium chemistry
- Abstract
Abnormalities in atrial myocardium increase the likelihood of arrhythmias, including atrial fibrillation (AF). The deposition of misfolded protein, or amyloidosis, plays an important role in the pathophysiology of many diseases, including human cardiomyopathies. We have shown that genes implicated in amyloidosis are activated in a cellular model of AF, with the development of preamyloid oligomers (PAOs). PAOs are intermediates in the formation of amyloid fibrils, and they are now recognized to be the cytotoxic species during amyloidosis. To investigate the presence of PAOs in human atrium, we developed a microscopic imaging-based protocol to enable robust and reproducible quantitative analysis of PAO burden in atrial samples harvested at the time of elective cardiac surgery. Using PAO- and myocardial-specific antibodies, we found that PAO distribution was typically heterogeneous within a myocardial sample. Rigorous imaging and analysis protocols were developed to quantify the relative area of myocardium containing PAOs, termed the Green/Red ratio (G/R), for a given sample. Using these methods, reproducible G/R values were obtained when different sections of a sample were independently processed, imaged, and analyzed by different investigators. This robust technique will enable studies to investigate the role of this novel structural abnormality in the pathophysiology of and arrhythmia generation in human atrial tissue., (© The Author(s) 2014.)
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- 2014
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38. Heme Oxygenase-1 and Acute Kidney Injury following Cardiac Surgery.
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Billings FT 4th, Yu C, Byrne JG, Petracek MR, and Pretorius M
- Abstract
Background: Intraoperative hemolysis and inflammation are associated with acute kidney injury (AKI) following cardiac surgery. Plasma-free hemoglobin induces heme oxygenase-1 (HO-1) expression. HO-1 degrades heme but increases in experimental models of AKI. This study tested the hypothesis that plasma HO-1 concentrations are associated with intraoperative hemolysis and are increased in patients that develop AKI following cardiac surgery., Methods: We measured plasma HO-1, free hemoglobin, and inflammatory markers in 74 patients undergoing cardiopulmonary bypass (CPB). AKI was defined as an increase in serum creatinine concentration of 50% or 0.3 mg/dl within 72 h of surgery., Results: Twenty-eight percent of patients developed AKI. HO-1 concentrations increased from 4.2 ± 0.2 ng/ml at baseline to 6.6 ± 0.5 ng/ml on postoperative day (POD) 1 (p < 0.001). POD1 HO-1 concentrations were 3.1 ng/ml higher (95% CI 1.1-5.1) in AKI patients, as was the change in HO-1 from baseline to POD1 (4.4 ± 1.3 ng/ml in AKI patients vs. 1.5 ± 0.3 ng/ml in no-AKI patients, p = 0.006). HO-1 concentrations remained elevated in AKI patients even after controlling for AKI risk factors and preoperative drug therapy. Peak-free hemoglobin concentrations correlated with peak HO-1 concentrations on POD1 in patients that developed AKI (p = 0.02). Duration of CPB and post-CPB IL-6 and IL-10 concentrations were also associated with increased HO-1 on POD1., Conclusion: Plasma HO-1 is increased in patients that develop AKI, and CPB duration, hemolysis, and inflammation are associated with increased HO-1 concentrations following cardiac surgery. Strategies that alter hemolysis and HO-1 expression during cardiac surgery may affect risk for AKI.
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- 2014
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39. Type A aortic dissection in Marfan syndrome: a case for more aggressive and extensive surgery at the time of the initial surgical operation.
- Author
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Leacche M and Byrne JG
- Subjects
- Female, Humans, Male, Aortic Aneurysm etiology, Aortic Aneurysm surgery, Cardiovascular Surgical Procedures methods, Marfan Syndrome complications
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- 2014
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40. Current readings: Status of surgical treatment for endocarditis.
- Author
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Neely RC, Leacche M, Shah J, and Byrne JG
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- Female, Humans, Male, Aortic Valve, Disease Management, Echocardiography methods, Embolism prevention & control, Endocarditis mortality, Endocarditis surgery, Endocarditis therapy, Endocarditis, Bacterial surgery, Heart Valve Diseases therapy, Heart Valve Prosthesis microbiology, Practice Guidelines as Topic, Prosthesis-Related Infections surgery, Staphylococcal Infections therapy, Tricuspid Valve surgery
- Abstract
Valve endocarditis is associated with high morbidity and mortality and requires a thorough evaluation including early surgical consultation to identify patients who may benefit from surgery. We review 5 recent articles that highlight the current debates related to best treatment strategies for valve endocarditis. Recent publications have focused on neurologic risk assessment, timing of surgery, and prognostic factors associated with native and prosthetic valve endocarditis. The initial patient assessment and management is best performed by a multidisciplinary team. Future investigations should focus on identifying surgical candidates early and the outcomes affected by replacement valve choice in both native and prosthetic valve endocarditis., (Copyright © 2014. Published by Elsevier Inc.)
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- 2014
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41. Cross-sectional survey on minimally invasive mitral valve surgery.
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Misfeld M, Borger M, Byrne JG, Chitwood WR, Cohn L, Galloway A, Garbade J, Glauber M, Greco E, Hargrove CW, Holzhey DM, Krakor R, Loulmet D, Mishra Y, Modi P, Murphy D, Nifong LW, Okamoto K, Seeburger J, Tian DH, Vollroth M, and Yan TD
- Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS., Methods: Surgeons experienced in MIMVS were identified through an electronic search of the literature. A link to an online survey platform was sent to all surgeons, as well as two follow-up reminders. Survey responses were then submitted to a central database and analyzed., Results: The survey was completed by 20 surgeons. Overall results were not uniform with regard to contraindications to performing MIMVS. Some respondents do not consider left atrial enlargement (95% of surgeons), complexity of surgery (75%), age (70%), aortic calcification (70%), EuroSCORE (60%), left ventricular ejection fraction (55%), or obesity (50%) to be contraindication to surgery. Ninety percent of respondents believe more than 20 cases are required to gain familiarity with the procedure, while 85% believe at least one MIMVS case needs to be performed per week to maintain proficiency. Eighty percent recommend establishment of multi-institutional databases and standardized surgical mentoring courses, while 75% believe MIMVS should be incorporated into current training programs for trainees., Conclusions: These results suggest that MIMVS has been accepted as a treatment option for patients with mitral valve pathologies according the expert panel. Initial training and continuing practice is recommended to maintain proficiency, as well as further research and formalization of training programs.
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- 2013
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42. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures: a Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Revise the 2007 Clinical Competence Statement on Cardiac Interventional Procedures).
- Author
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE Jr, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, and Weitz HH
- Subjects
- Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary education, Cardiac Catheterization adverse effects, Consensus, Coronary Artery Disease diagnosis, Humans, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention education, Quality Improvement standards, Quality Indicators, Health Care standards, Risk Factors, Treatment Outcome, Angioplasty, Balloon, Coronary standards, Cardiac Catheterization standards, Clinical Competence standards, Coronary Artery Disease therapy, Education, Medical, Graduate standards, Percutaneous Coronary Intervention standards
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- 2013
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43. Episodic monoplane transesophageal echocardiography impacts postoperative management of the cardiac surgery patient.
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Maltais S, Costello WT, Billings FT 4th, Bick JS, Byrne JG, Ahmad RM, and Wagner CE
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- APACHE, Cardiac Tamponade diagnostic imaging, Cardiac Tamponade physiopathology, Critical Care, Critical Illness, Fluid Therapy, Hemodynamics, Humans, Hypovolemia physiopathology, Pericardial Effusion diagnostic imaging, Prospective Studies, Vasoconstrictor Agents therapeutic use, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Dysfunction, Right physiopathology, Cardiac Surgical Procedures methods, Echocardiography, Transesophageal methods, Postoperative Care methods
- Abstract
Objective: A new slender, flexible, and miniaturized disposable monoplane transesophageal TEE probe has been approved for episodic hemodynamic transesophageal echocardiographic monitoring. The authors hypothesized that episodic monoplane TEE with a limited examination would help guide the postoperative management of high-risk cardiac surgery patients., Design: The authors analyzed the initial consecutive observational experience with the miniaturized transesophageal echocardiography monitoring system (ClariTEE, ImaCor, Uniondale, New York)., Setting: Single institution in a university setting., Participants: Unstable cardiac surgery patients., Interventions: The authors assessed fluid responsiveness, echocardiographic data, and concordance among hemodynamic data., Measurements and Main Results: From June 2010 to February 2011, 21 unstable cardiac surgery patients with postoperative instability were identified. Two patients (10%) required reoperation for bleeding and tamponade physiology. Right ventricular dysfunction was diagnosed by episodic TEE monitoring in 7 patients (33%), while hypovolemia was documented in 12 patients (57%). Volume responsiveness was documented in 11 patients. In this observational study, discordance between hemodynamic monitoring and episodic TEE was qualitatively observed in 14 patients (66%)., Conclusion: The authors demonstrated the ability of episodic monoplane TEE to identify discordance between hemodynamic monitoring to better define clinical scenarios in unstable cardiac surgery patients. For these challenging patients, limited episodic TEE assessment has become a cornerstone of ICU care in this institution., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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44. Contemporary management of tricuspid regurgitation: an updated clinical review.
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Taylor JT, Chidsey G, Disalvo TG, Byrne JG, and Maltais S
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Cardiovascular Surgical Procedures, Heart-Assist Devices, Humans, Incidence, Tricuspid Valve pathology, Tricuspid Valve physiopathology, Tricuspid Valve surgery, Tricuspid Valve Insufficiency epidemiology, Disease Management, Tricuspid Valve Insufficiency physiopathology, Tricuspid Valve Insufficiency therapy
- Abstract
Tricuspid regurgitation (TR) is a complex and insidious valvular pathology that represents a complex decision and management algorithm for patients. TR is present in a significant proportion of the population and is especially prevalent in patients with advanced heart failure. Patients with TR have been demonstrated to have a decreased survival even with normal left heart function. TR can be a result of pathology that directly affects the valvular structure (i.e., Ebstein anomaly) or as a result of increased forward pressures (ie, pulmonary hypertension, left heart failure). Conservative management of patients with TR is primarily symptomatic relief. Definitive therapy involves surgical repair of the tricuspid valve. Furthermore, as more patients develop advanced heart failure, the management of TR in patients with left ventricular assist devices has become necessary because of the evidence of increased in-hospital morbidity and a trend toward decreased survival.
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- 2013
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45. Stem cell therapy for chronic heart failure: an updated appraisal.
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Maltais S, Joggerst SJ, Hatzopoulos A, DiSalvo TG, Zhao D, Sung HJ, Wang X, Byrne JG, and Naftilan AJ
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- Animals, Bone Marrow Transplantation methods, Bone Marrow Transplantation trends, Cell- and Tissue-Based Therapy methods, Cell- and Tissue-Based Therapy trends, Chronic Disease, Clinical Trials as Topic methods, Clinical Trials as Topic trends, Heart Failure diagnosis, Humans, Heart Failure therapy, Stem Cell Transplantation methods, Stem Cell Transplantation trends
- Abstract
Introduction: Significant advances have been made to understand the mechanisms involved in cardiac cell-based therapies. The early translational application of basic science knowledge has led to several animal and human clinical trials. The initial promising beneficial effect of stem cells on cardiac function restoration has been eclipsed by the inability of animal studies to translate into sustained clinical improvements in human clinical trials., Areas Covered: In this review, the authors cover an updated overview of various stem cell populations used in chronic heart failure. A critical review of clinical trials conducted in advanced heart failure patients is proposed, and finally promising avenues for developments in the field of cardiac cell-based therapies are presented., Expert Opinion: Several questions remain unanswered, and this limits our ability to understand basic mechanisms involved in stem cell therapeutics. Human studies have revealed critical unresolved issues. Further elucidation of the proper timing, mode delivery and prosurvival factors is imperative, if the field is to advance. The limited benefits seen to date are simply not enough if the potential for substantial recovery of nonfunctioning myocardium is to be realized.
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- 2013
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46. A comparison of hybrid coronary revascularization and off-pump coronary revascularization.
- Author
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Umakanthan R, Leacche M, Gallion AH, and Byrne JG
- Abstract
Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.
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- 2013
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47. Contribution of endogenous bradykinin to fibrinolysis, inflammation, and blood product transfusion following cardiac surgery: a randomized clinical trial.
- Author
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Balaguer JM, Yu C, Byrne JG, Ball SK, Petracek MR, Brown NJ, and Pretorius M
- Subjects
- Antifibrinolytic Agents therapeutic use, Bradykinin antagonists & inhibitors, Bradykinin therapeutic use, Female, Fibrin Fibrinogen Degradation Products metabolism, Fibrinolysis drug effects, Humans, Male, Middle Aged, Postoperative Complications, Postoperative Hemorrhage drug therapy, Aminocaproic Acid therapeutic use, Blood Transfusion statistics & numerical data, Bradykinin analogs & derivatives, Bradykinin physiology, Bradykinin Receptor Antagonists, Cardiopulmonary Bypass adverse effects, Fibrinolysis physiology, Inflammation drug therapy
- Abstract
Bradykinin increases during cardiopulmonary bypass (CPB) and stimulates the release of nitric oxide, inflammatory cytokines, and tissue-type plasminogen activator (t-PA), acting through its B2 receptor. This study tested the hypothesis that endogenous bradykinin contributes to the fibrinolytic and inflammatory response to CPB and that bradykinin B2 receptor antagonism reduces fibrinolysis, inflammation, and subsequent transfusion requirements. Patients (N = 115) were prospectively randomized to placebo, ε-aminocaproic acid (EACA), or HOE 140, a bradykinin B2 receptor antagonist. Bradykinin B2 receptor antagonism decreased intraoperative fibrinolytic capacity as much as EACA, but only EACA decreased D-dimer formation and tended to decrease postoperative bleeding. Although EACA and HOE 140 decreased fibrinolysis and EACA attenuated blood loss, these treatments did not reduce the proportion of patients transfused. These data suggest that endogenous bradykinin contributes to t-PA generation in patients undergoing CPB, but that additional effects on plasmin generation contribute to decreased D-dimer concentrations during EACA treatment.
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- 2013
- Full Text
- View/download PDF
48. Comparison of 30-day outcomes of coronary artery bypass grafting surgery verus hybrid coronary revascularization stratified by SYNTAX and euroSCORE.
- Author
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Leacche M, Byrne JG, Solenkova NS, Reagan B, Mohamed TI, Fredi JL, and Zhao DX
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Coronary Artery Bypass methods, Coronary Artery Disease surgery
- Abstract
Objective: The optimal treatment of multivessel coronary artery disease is not well established. Hybrid coronary revascularization by combining the left internal mammary artery-left anterior descending artery graft and drug-eluting stents in non-left anterior descending artery territories might offer superior results compared with sole coronary artery bypass grafting or sole percutaneous coronary intervention., Methods: We retrospectively analyzed the 30-day outcomes of 381 consecutive patients undergoing coronary artery bypass grafting (n = 301) vs hybrid coronary revascularization (n = 80). In a 2 × 2 matrix, the 2 groups were stratified by the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (≤32 vs ≥33) and the European System for Cardiac Operative Risk Evaluation (euroSCORE) (<5 vs ≥5). The composite endpoint (death from any cause, stroke, myocardial infarction, low cardiac output syndrome) and secondary endpoints (worsening postprocedural renal function and bleeding) were determined., Results: After stratification using the SYNTAX and the euroSCORE, the preoperative characteristics were similar within the 4 groups, except for the ≥33 SYNTAX/>5 euroSCORE. The hybrid coronary revascularization patients were older (77 vs 65 years, P = .001). The postoperative outcomes using combined SYNTAX and the euroSCORE stratification showed a similar rate of the composite endpoint for all groups except for patients with ≥33 SYNTAX/>5 euroSCORE (0% for the coronary artery bypass grafting group vs 33% for the hybrid coronary revascularization group, P = .001). An analysis of the secondary endpoint showed similar results across all groups, except for in the ≥33 SYNTAX/>5 euroSCORE group, in which bleeding (re-exploration for bleeding and transfusion >3 packed red blood cell units per patient) was 44% in the hybrid coronary revascularization group vs 11% in the coronary artery bypass grafting group (P = .05)., Conclusions: Hybrid coronary revascularization is a safe alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. However, in high-risk patients with complex coronary artery disease (≥33 SYNTAX/>5 euroSCORE), coronary artery bypass grafting is superior to hybrid coronary revascularization., (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
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- 2013
- Full Text
- View/download PDF
49. Minimally invasive mitral valve surgery: current status.
- Author
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Cohn LH and Byrne JG
- Subjects
- Cardiac Catheterization, Humans, Robotics, Treatment Outcome, Cardiac Valve Annuloplasty methods, Minimally Invasive Surgical Procedures methods, Mitral Valve surgery, Mitral Valve Insufficiency surgery
- Published
- 2013
50. Minimally invasive bypass surgery for stenosis of the left anterior descending artery: 10-year results from a randomized controlled trial.
- Author
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Byrne JG and Leacche M
- Subjects
- Humans, Coronary Artery Bypass, Coronary Stenosis therapy, Metals, Percutaneous Coronary Intervention instrumentation, Stents
- Published
- 2013
- Full Text
- View/download PDF
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