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248 results on '"Poston, Robert S"'

25. Change management and an innovative approach to heart bypass surgery

Author

Kurian, Dinesh, Gorcos, Jennifer, Meinke, Sara, Thirumavalavan, Nannan, Mizrahi, Ilan, Kiani, Soroosh, Desai, Pranjal, and Poston, Robert S.

Subjects
Care and treatment, Health aspects, Heart surgery -- Health aspects, Heart diseases -- Care and treatment, Heart -- Surgery
Abstract

In this article. ... Take a look at the milestones and potential pitfalls one group faced when attempting to introduce innovation to cardiac surgery. Over the past several decades, cardiac [...]

Published
2011

42. Mortality Benefit with Prasugrel in the TRITON-TIMI 38 Coronary Artery Bypass Grafting (CABG) Cohort: Risk-Adjusted Retrospective Data Analysis

Author

Smith, Peter K, Goodnough, Lawrence T, Levy, Jerrold H, Poston, Robert S, Short, Mary A, Weerakkody, Govinda J, and LeNarz, LeRoy A

Subjects
Male, Ticlopidine, Blood Loss, Surgical, Hemorrhage, Thiophenes, Article, Drug Administration Schedule, Piperazines, Cohort Studies, Recurrence, Cause of Death, Humans, Acute Coronary Syndrome, Angioplasty, Balloon, Coronary, Coronary Artery Bypass, Aged, Retrospective Studies, Aspirin, Middle Aged, Combined Modality Therapy, Clopidogrel, Chest Tubes, Drug Therapy, Combination, Female, Risk Adjustment, Erythrocyte Transfusion, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

The objective of this study was to characterize the bleeding, transfusion, and other outcomes of patients related to the timing of prasugrel or clopidogrel withdrawal before coronary artery bypass grafting (CABG).There is little evidence to guide clinical decision making regarding the use of prasugrel in patients who may need urgent or emergency CABG. Experience with performing CABG in the presence of clopidogrel has raised concern about perioperative bleeding complications that are unresolved.A subset of the TRITON-TIMI 38 study (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis In Myocardial Infarction 38), in which patients with acute coronary syndrome were randomized to treatment with aspirin and either clopidogrel or prasugrel, underwent isolated CABG (N = 346). A supplemental case report form was designed and administered, and the data combined with the existing TRITON-TIMI 38 database. Baseline imbalances were corrected for using elements of the European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons predictive algorithm.A significantly higher mean 12-h chest tube blood loss (655 ± 580 ml vs. 503 ± 378 ml; p = 0.050) was observed with prasugrel compared with clopidogrel, without significant differences in red blood cell transfusion (2.1 U vs. 1.7 U; p = 0.442) or the total donor exposure (4.4 U vs. 3.0 U; p = 0.463). All-cause mortality was significantly reduced with prasugrel (2.31%) compared with 8.67% with clopidogrel (adjusted odds ratio: 0.26; p = 0.025).Despite an increase in observed bleeding, platelet transfusion, and surgical re-exploration for bleeding, prasugrel was associated with a lower rate of death after CABG compared with clopidogrel.

Published
2012

43. Comparison of Economic and Patient Outcomes With Minimally Invasive Versus Traditional Off-Pump Coronary Artery Bypass Grafting Techniques

Author

Poston, Robert S., Tran, Richard, Collins, Michael, Reynolds, Marty, Connerney, Ingrid, Reicher, Barry, Zimrin, David, Griffith, Bartley P., and Bartlett, Stephen T.

Subjects
Male, Cost-Benefit Analysis, Coronary Artery Bypass, Off-Pump, Coronary Artery Disease, Robotics, Length of Stay, Middle Aged, Article, United States, Treatment Outcome, Quality of Life, Humans, Minimally Invasive Surgical Procedures, Female, Prospective Studies, Hospital Costs, Aged
Abstract

Minimally invasive coronary artery bypass grafting (miniCABG) decreases in-hospital morbidity versus traditional sternotomy CABG. We performed a prospective cohort study (NCT00481806) to assess the impact of miniCABG on costs and metrics that influence quality of life after hospital discharge.One hundred consecutive miniCABG cases performed using internal mammary artery (IMA) grafting +/- coronary stenting were compared with a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.7 vs. 2.9), off-pump. We compared perioperative costs, time to return to work/normal activity, and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1 year: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1 year), stroke, or death.For miniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (4.80 +/- 6.35 vs. 12.24 +/- 6.24 hours), hospital stay (3.77 +/- 1.51 vs. 6.38 +/- 2.23 days), and transfusion (0.16 +/- 0.37 vs. 1.37 +/- 1.35 U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t = -2.15; P = 0.04), whereas sternotomy CABG increased MACCE (HR, 3.9; 95% CI, 1.4-7.6), largely from lower target-vessel patency.MiniCABG shortens patient recovery time, minimizes MACCE risk at 1 year, and showed superior quality and outcome metrics versus standard-of-care CABG. These findings occurred without increasing costs and with superior target vessel graft patency.

Published
2008

44. Reply

Author

Kiani, Soroosh, primary and Poston, Robert S., additional

Published
2013
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