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https://www.readbyqxmd.com/read/27717426/the-racial-paradox-in-multiarterial-conduit-utilization-for-coronary-artery-bypass-grafting
#1
W Brent Keeling, Jose Binongo, Michael E Halkos, Bradley G Leshnower, Duc Q Nguyen, Edward P Chen, Eric L Sarin, Jeffrey S Miller, Steven Macheers, Omar M Lattouf, Robert A Guyton, Vinod H Thourani
BACKGROUND: It has been established that outcomes for black patients undergoing coronary artery bypass graft surgery (CABG) are inferior to those of their white counterparts. The purpose of this study was to determine (1) whether rates of multiarterial grafting are different among black patients and white patients, and (2) whether racial differences exist in postoperative outcomes after accounting for grafting strategy. METHODS: A retrospective review of black patients (n = 2,810) and white patients (n = 13,569) who underwent isolated, primary CABG from January 2002 to June 2014 at a US academic institution was performed...
October 4, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/26992603/midterm-benefits-of-surgical-pulmonary-embolectomy-for-acute-pulmonary-embolus-on-right-ventricular-function
#2
William Brent Keeling, Bradley G Leshnower, Yi Lasajanak, Jose Binongo, Robert A Guyton, Michael E Halkos, Vinod H Thourani, Omar M Lattouf
OBJECTIVE: Surgical pulmonary embolectomy has been used for the successful treatment of massive and submassive pulmonary emboli. The purpose of this study is to document the short- and midterm echocardiographic follow-up of right ventricular function after surgical pulmonary embolectomy for acute pulmonary embolus. METHODS: A retrospective review of the local Society of Thoracic Surgeons database of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from 1998 to 2014 at a US academic center...
September 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/26687889/hybrid-coronary-revascularization-versus-coronary-artery-bypass-surgery-with-bilateral-or-single-internal-mammary-artery-grafts
#3
COMPARATIVE STUDY
Joshua M Rosenblum, Ralf E Harskamp, Niels Hoedemaker, Patrick Walker, Henry A Liberman, Robert J de Winter, Thomas A Vassiliades, John D Puskas, Michael E Halkos
OBJECTIVE: Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery (LIMA)-left anterior descending artery (LAD) bypass with percutaneous intervention of non-LAD vessels. The purpose of this study was to compare outcomes of HCR to conventional coronary artery bypass graft (CABG) surgery with single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting. METHODS: Between October 2003 and September 2013, 306 consecutive patients who underwent HCR were compared with 8254 patients who underwent CABG with SIMA (7381; 89...
April 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/26296272/the-expanding-role-of-endoscopic-robotics-in-mitral-valve-surgery-1-257-consecutive-procedures
#4
Douglas A Murphy, Emmanuel Moss, Jose Binongo, Jeffrey S Miller, Steven K Macheers, Eric L Sarin, Alexander M Herzog, Vinod H Thourani, Robert A Guyton, Michael E Halkos
BACKGROUND: The role of robotic instruments in mitral valve (MV) surgery continues to evolve. The purpose of this study was to assess the safety, efficacy, and scope of MV surgery using a lateral endoscopic approach with robotics (LEAR) technique. METHODS: From 2006 to 2013, a dedicated LEAR team performed 1,257 consecutive isolated MV procedures with or without tricuspid valve repair or atrial ablation. The procedures were performed robotically through five right-side chest ports with femoral artery or ascending aortic perfusion and balloon occlusion...
November 2015: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/25933731/effect-of-surgical-atrial-fibrillation-ablation-at-the-time-of-cardiac-surgery-on-risk-of-postoperative-pacemaker-implantation
#5
COMPARATIVE STUDY
Mikhael F El-Chami, José Nilo G Binongo, Mathew Levy, Faisal M Merchant, Michael Halkos, Vinod Thourani, Omar Lattouf, Robert Guyton, John Puskas, Angel R Leon
The aim of this study was to retrospectively investigate whether performing surgical atrial fibrillation (AF) ablation in conjunction with cardiac surgery (CS) increases the risk for postoperative permanent pacemaker (PPM) requirement. The 30-day risk for PPM requirement was analyzed in consecutive patients who underwent CS from January 2007 to August 27, 2013. Patients were divided into 3 groups: (1) those who underwent AF ablation concomitant with CS (AF ABL), (2) patients with any history of AF who underwent surgery who did not undergo ablation (AF NO ABL), and (3) those with no histories of AF who underwent surgery (NO AF)...
July 1, 2015: American Journal of Cardiology
https://www.readbyqxmd.com/read/25293356/avoiding-aortic-clamping-during-coronary-artery-bypass-grafting-reduces-postoperative-stroke
#6
COMPARATIVE STUDY
Emmanuel Moss, John D Puskas, Vinod H Thourani, Patrick Kilgo, Edward P Chen, Bradley G Leshnower, Omar M Lattouf, Robert A Guyton, Kathryn E Glas, Michael E Halkos
OBJECTIVE: The purpose of this study was to determine whether the incidence of postoperative stroke could be reduced by eliminating aortic clamping during coronary artery bypass grafting. METHODS: From 2002 to 2013, 12,079 patients underwent primary, isolated coronary artery bypass grafting at a single US academic institution. Aortic manipulation was completely avoided by using in situ internal thoracic arteries for inflow in 1552 patients (12.9%) (no-touch), a clampless facilitating device for proximal anastomoses in 1548 patients (12...
January 2015: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/24820188/first-nationwide-survey-of-us-integrated-6-year-cardiothoracic-surgical-residency-program-directors
#7
Amir H Lebastchi, John J Tackett, Michael Argenziano, John H Calhoon, Mario G Gasparri, Michael E Halkos, George L Hicks, Mark D Iannettoni, John S Ikonomidis, Patrick M McCarthy, Sandra L Starnes, Betty C Tong, David D Yuh
OBJECTIVE: The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. METHODS: A 28-question web-based survey was distributed to program directors of all 24 Accreditation Council for Graduate Medical Education-accredited I-6 training programs in November 2013. The response rate was a robust 67%...
August 2014: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/24726605/incidence-of-postoperative-stroke-using-the-heartstring-device-in-1-380-coronary-artery-bypass-graft-patients-with-mild-to-severe-atherosclerosis-of-the-ascending-aorta
#8
Vinod H Thourani, Seyed Amirhossein Razavi, Tom C Nguyen, Patrick D Kilgo, John D Puskas, Robert A Guyton, Omar M Lattouf, Bradley G Leshnower, Edward P Chen, Eric L Sarin, Michael E Halkos
BACKGROUND: Atherosclerotic disease of the ascending aorta during coronary artery bypass graft surgery (CABG) increases the risk for postoperative stroke. The objective of this study was to examine the incidence of postoperative stroke in CABG utilizing the Heartstring (Maquet Cardiovascular, San Jose, CA) proximal anastomotic device. METHODS: Intraoperative epiaortic ultrasonography was used to grade atherosclerosis in CABG patients at Emory University from April 2003 to December 2012...
June 2014: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/24636706/the-impact-of-hybrid-coronary-revascularization-on-hospital-costs-and-reimbursements
#9
COMPARATIVE STUDY
Michael E Halkos, Lauren Ford, Dane Peterson, Sheryl M Bluestein, Henry A Liberman, Patrick Kilgo, John D Puskas, Robert A Guyton, Ritam Chowdhury
BACKGROUND: Hybrid coronary revascularization (HCR) combines a minimally invasive, left internal mammary artery-left anterior descending coronary artery (LAD) bypass with percutaneous intervention of non-LAD vessels for patients with multivessel coronary disease. The financial implications of HCR have not been compared with off-pump coronary artery bypass (OPCAB) through sternotomy. METHODS: The contribution margin is a fiduciary calculation (best hospital payment estimate--total variable costs) used by hospitals to determine fiscal viability of services...
May 2014: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/24383387/postoperative-warfarin-following-mitral-valve-repair-or-bioprosthetic-valve-replacement
#10
COMPARATIVE STUDY
Vinod H Thourani, Rebecca L Gunter, Stuart Hurst, Patrick Kilgo, Murali Padala, John D Puskas, Omar M Lattouf, Michael E Halkos, Robert A Guyton
BACKGROUND AND AIM OF THE STUDY: Short-term postoperative warfarin therapy has been used to decrease neurologic events following mitral valve repair or bioprosthetic replacement (MVR). The study aim was to compare the short- and long-term outcomes of patients undergoing mitral valve surgery with or without short-term postoperative warfarin. METHODS: A single academic US institution retrospective review was performed on discharged patients who underwent MVR between January 1996 and March 2010...
September 2013: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/24283711/long-term-survival-for-patients-with-metabolic-syndrome-after-bioprosthetic-or-mechanical-valve-replacement
#11
Marek Polomsky, Patrick D Kilgo, John D Puskas, Michael E Halkos, Vinod H Thourani, Heval M Kelli, Robert A Guyton, Omar M Lattouf
BACKGROUND: Metabolic diseases are thought to negatively impact the long-term survival of cardiac patients and have been shown to be associated with reduced durability of bioprosthetic heart valves. The purpose of this study is to determine whether long-term survival of post-valve replacement patients is affected by the presence of metabolic disease, and whether choice of tissue versus mechanical prosthesis impacts survival. METHODS: A retrospective review was conducted of all isolated valve replacements performed between 2002 and 2011 from the STS adult cardiac database of Emory Healthcare Hospitals...
January 2014: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/24021772/acute-type-a-dissection-impact-of-antegrade-cerebral-perfusion-under-moderate-hypothermia
#12
COMPARATIVE STUDY
George M Comas, Bradley G Leshnower, Michael E Halkos, Vinod H Thourani, John D Puskas, Robert A Guyton, Patrick D Kilgo, Edward P Chen
BACKGROUND: The optimal method of arterial cannulation and circulation management for acute type A aortic dissection (type A) remains debated. Moderate hypothermic circulatory arrest (MHCA) and unilateral selective antegrade cerebral perfusion (uSACP) is effective in the elective setting. In this study, the impact of MHCA and uSACP on outcomes for type A repair was evaluated. METHODS: A retrospective review identified 346 patients who underwent type A repair under circulatory arrest, including 193 patients who had MHCA/uSACP...
December 2013: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/23968758/impact-of-preoperative-chronic-lung-disease-on-survival-after-surgical-aortic-valve-replacement
#13
Rebecca L Gunter, Patrick Kilgo, Robert A Guyton, Edward P Chen, John D Puskas, William A Cooper, Michael E Halkos, Omar M Lattouf, Vasilis Babaliaros, Richard Myung, Bradley Leshnower, Vinod H Thourani
BACKGROUND: An increasing number of patients requiring surgical aortic valve replacement (SAVR) present with chronic pulmonary obstructive disease (COPD). The purpose of this study was to compare patients who had a range of COPD from normal to severe and were undergoing SAVR. METHODS: Retrospective review of 2,379 patients undergoing SAVR ± coronary artery bypass grafting (CABG) from January 2002 to April 2012 at a US academic institution was performed. COPD was defined according to the Society of Thoracic Surgeons (STS) adult cardiac database: normal (forced expiratory volume [FEV] > 75% predicted), mild (FEV in 1 second [FEV1] 60%-75%), moderate (FEV1 50%-59%), and severe (FEV1 < 50%)...
October 2013: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/23477689/trends-in-aortic-clamp-use-during-coronary-artery-bypass-surgery-effect-of-aortic-clamping-strategies-on-neurologic-outcomes
#14
William T Daniel, Patrick Kilgo, John D Puskas, Vinod H Thourani, Omar M Lattouf, Robert A Guyton, Michael E Halkos
OBJECTIVE: The purpose of the present study was to determine the effect of different clamping strategies during coronary artery bypass grafting on the incidence of postoperative stroke. METHODS: In the present case-control study, all patients at Emory hospitals from 2002 to 2009 with postoperative stroke after isolated coronary artery bypass grafting (n = 141) were matched 1:4 to a contemporaneous cohort of patients without postoperative stroke (n = 565). The patients were matched according to the Society of Thoracic Surgeons' predicted risk of postoperative stroke score, which is based on 26 variables...
February 2014: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/23245447/the-impact-of-specific-preoperative-organ-dysfunction-in-patients-undergoing-aortic-valve-replacement
#15
COMPARATIVE STUDY
Vinod H Thourani, Ritam Chowdhury, Rebecca L Gunter, Patrick D Kilgo, Edward P Chen, John D Puskas, Michael E Halkos, Omar M Lattouf, William A Cooper, Robert A Guyton
BACKGROUND: Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes. METHODS: A total of 1,759 aortic valve replacement cases with and without coronary artery bypass grafting performed from January 2002 to June 2010 at Emory University are the basis for this retrospective analysis...
March 2013: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/23177295/ventricular-arrhythmia-after-cardiac-surgery-incidence-predictors-and-outcomes
#16
COMPARATIVE STUDY
Mikhael F El-Chami, Fadi J Sawaya, Patrick Kilgo, William Stein, Michael Halkos, Vinod Thourani, Omar M Lattouf, David B Delurgio, Robert A Guyton, John D Puskas, Angel R Leon
OBJECTIVES: This study sought to investigate the prevalence, predictors, and outcomes of patients with post-operative ventricular arrhythmia (POVA) in a large cohort of patients. BACKGROUND: New-onset POVA after cardiac surgery (CS) is uncommon and has controversial prognostic value. METHODS: A total of 14,720 consecutive patients undergoing CS at Emory University between January 2004 and July 2010 were included in the study. Data on all-cause mortality were obtained from Social Security Administration death records...
December 25, 2012: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/23084105/off-pump-coronary-artery-bypass-grafting-attenuates-morbidity-and-mortality-for-patients-with-low-and-high-body-mass-index
#17
W Brent Keeling, Patrick D Kilgo, John D Puskas, Michael E Halkos, Omar M Lattouf, Robert A Guyton, Vinod H Thourani
BACKGROUND: Patients at high and low body mass index have been shown to experience higher morbidity and mortality when undergoing coronary artery bypass grafting. The purpose of this research was to compare outcomes of patients at body mass index extremes who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. METHODS: A retrospective review of 6801 patients with a body mass index <25 or >35 undergoing isolated, primary coronary artery bypass grafting from 1996 to 2009 at Emory Healthcare Hospitals was performed...
December 2013: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/22776082/sternotomy-versus-nonsternotomy-lima-lad-grafting-for-single-vessel-disease
#18
Michael E Halkos, Thomas A Vassiliades, Richard J Myung, Patrick Kilgo, Vinod H Thourani, William A Cooper, Robert A Guyton, Omar M Lattouf, John D Puskas
BACKGROUND: Single-vessel disease of the left anterior descending (LAD) coronary artery may be surgically revascularized by left internal mammary artery (LIMA) grafting either through a sternotomy or a nonsternotomy approach. Nonsternotomy approaches are used in the hope of achieving a less invasive operation. It is unknown whether nonsternotomy approaches impact in-hospital or midterm outcomes. METHODS: The institutional Society of Thoracic Surgeons (STS) database at a single US academic center was reviewed for 597 consecutive patients treated surgically for single-vessel LAD disease from January 1, 2002 to June 30, 2011...
November 2012: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/22621801/prediction-of-new-onset-atrial-fibrillation-after-cardiac-revascularization-surgery
#19
COMPARATIVE STUDY
Mikhael F El-Chami, Patrik D Kilgo, K Miriam Elfstrom, Michael Halkos, Vinod Thourani, Omar M Lattouf, David B Delurgio, Robert A Guyton, Angel R Leon, John D Puskas
The aim of this study was to create a simple risk index to predict new-onset atrial fibrillation (AF) after coronary artery bypass grafting in patients with histories of AF. AF after coronary artery bypass grafting (referred to here as AF) is associated with increased morbidity and mortality. Identifying patients at high risk for developing AF may help identify a group of patients who might benefit from strategies to prevent postoperative AF. A cohort of 18,517 patients enrolled from January 1, 1996, to December 31, 2009, was used to derive a risk index for AF prediction...
September 1, 2012: American Journal of Cardiology
https://www.readbyqxmd.com/read/22503849/risk-factors-for-conversion-to-cardiopulmonary-bypass-during-off-pump-coronary-artery-bypass-surgery
#20
Ritam Chowdhury, Darcy White, Patrick Kilgo, John D Puskas, Vinod H Thourani, Edward P Chen, Omar M Lattouf, William A Cooper, Richard J Myung, Robert A Guyton, Michael E Halkos
BACKGROUND: Off-pump coronary artery bypass graft (OPCAB) may be associated with improved hospital outcomes compared with on-pump coronary artery bypass graft. However, intraoperative conversion to on-pump coronary artery bypass graft has been associated with adverse outcomes. The purpose of this study was to identify preoperative risk factors for intraoperative conversion in nonemergent patients undergoing isolated OPCAB. METHODS: From 2002 to 2010, 8,077 consecutive OPCAB cases were performed at a single US academic center...
June 2012: Annals of Thoracic Surgery
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