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Clark Hargrove

Eric J Lehr, T Sloane Guy, Robert L Smith, Eugene A Grossi, Richard J Shemin, Evelio Rodriguez, Gorav Ailawadi, Arvind K Agnihotri, Trevor M Fayers, W Clark Hargrove, Brian W Hummel, Junaid H Khan, S Chris Malaisrie, John R Mehall, Douglas A Murphy, William H Ryan, Arash Salemi, Romualdo J Segurola, J Michael Smith, J Alan Wolfe, Paul W Weldner, Glenn R Barnhart, Scott M Goldman, Clifton T P Lewis
Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.
July 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Matthew L Williams, Joseph E Bavaria, Michael A Acker, Nimesh D Desai, Prashanth Vallabhajosyula, W Clark Hargrove, Pavan Atluri, Wilson Y Szeto
BACKGROUND: When valve replacement is required in patients with end-stage renal disease (ESRD), it is not clear if mechanical or bioprosthetic valve selection is better. We compared outcomes between ESRD patients who underwent either mechanical or biologic valve replacements at our institution. METHODS: All patients with ESRD who underwent either mitral or aortic valve replacement from 2002 to 2014 at our institution were reviewed (n = 215; mechanical = 64, biological = 151)...
November 2016: Annals of Thoracic Surgery
George J Arnaoutakis, Prashanth Vallabhajosyula, Joseph E Bavaria, Ibrahim Sultan, Mary Siki, Suveeksha Naidu, Rita K Milewski, Matthew L Williams, W Clark Hargrove, Nimesh D Desai, Wilson Y Szeto
BACKGROUND: There remains concern that moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) may provide suboptimal distal organ protection compared with deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). We compared postoperative acute kidney injury (AKI) in in patients who underwent elective hemiarch repair with either DHCA/RCP or MHCA/ACP. METHODS: This was a retrospective review of all patients undergoing elective aortic hemiarch reconstruction for aneurysmal disease between 2009 and 2014...
October 2016: Annals of Thoracic Surgery
Arminder S Jassar, Prashanth Vallabhajosyula, Joseph E Bavaria, Jacob Gutsche, Nimesh D Desai, Matthew L Williams, Rita K Milewski, W Clark Hargrove, Wilson Y Szeto
OBJECTIVE: We describe an alternate technique for establishing antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest via direct, central cannulation of the innominate artery. METHODS: From 2009 to 2015, 100 elective hemiarch reconstructions for proximal aortic aneurysms were performed under moderate hypothermic circulatory arrest (MHCA). Cerebral perfusion was instituted with ACP via direct cannulation of the innominate artery. RESULTS: Mean patient age was 63 ± 13 years (72 men; 72%)...
April 2016: Journal of Thoracic and Cardiovascular Surgery
Prashanth Vallabhajosyula, Tyler Wallen, Aaron Pulsipher, Emil Pitkin, Lauren P Solometo, Shenara Musthaq, Jeanne Fox, Michael Acker, W Clark Hargrove
BACKGROUND: In patients requiring a second-time or more operation on the mitral valve (MV), we assessed whether the outcomes of the minimally invasive port access approach (port access group) were equivalent to those of the traditional redo sternotomy approach (redo sternotomy group). METHODS: In a retrospective review (1998-2011), 409 patients had previous MV operations requiring a second-time or more MV reintervention. Of those, 67 patients had the port access approach, and 342 had the redo sternotomy approach...
July 2015: Annals of Thoracic Surgery
Prashanth Vallabhajosyula, Arminder S Jassar, Rohan S Menon, Caroline Komlo, Jacob Gutsche, Nimesh D Desai, W Clark Hargrove, Joseph E Bavaria, Wilson Y Szeto
BACKGROUND: Deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (DHCA group) has traditionally been the cerebral protection strategy during transverse hemiarch aortic reconstruction. Recently, we have adopted moderate hypothermic (≥ 25 °C) circulatory arrest (MHCA) with antegrade cerebral perfusion (MHCA group). We compared the outcomes for these two circulatory arrest management strategies. METHODS: From 2008 to 2012, in a concurrent series of 376 patients (DHCA, 301; MHCA, 75) undergoing transverse hemiarch for aortic aneurysm disease, incidences of concomitant root replacement (44% vs 47%, p = 0...
May 2015: Annals of Thoracic Surgery
Jordan Goldhammer, William Clark Hargrove, William J Vernick
No abstract text is available yet for this article.
December 2015: Journal of Cardiothoracic and Vascular Anesthesia
Pavan Atluri, Andrew B Goldstone, Jeanne Fox, Wilson Y Szeto, W Clark Hargrove
BACKGROUND: Minimally invasive, right thoracotomy (port access) approaches to intracardiac operations (mitral valve, tricuspid valve, atrial septal defect, intracardiac tumors) are becoming increasingly accepted by surgeons, cardiologists, and patients alike. Standard techniques for cardioplegic arrest of the heart have included endoaortic balloons and Chitwood clamps. Concerns have been raised regarding the potential increased risk of vascular adverse events (embolization, dissection, stroke, lower extremity ischemia) associated with endoaortic balloon occlusion...
November 2014: Annals of Thoracic Surgery
Michael R DeLong, Duncan B Hughes, Jeffrey G Gaca, John P Fischer, Jennifer E Bond, W Clark Hargrove, Pavan Atluri, L Scott Levin, Detlev Erdmann
BACKGROUND: Median sternotomy may be associated with postoperative complications such as nonunion after conventional metal wire closure. The Sternal Talon device (KLS Martin, Jacksonville, FL) has recently been introduced as an alternative for osteosynthesis after median sternotomy and may also be beneficial for patients with persistent sternal nonunion. METHODS: A consecutive series of 24 patients underwent Sternal Talon repair for sternal nonunion or acute mediastinitis, or both, after sternal wire closure...
November 2014: Annals of Thoracic Surgery
Jianmin Yang, Lauren C Harte-Hargrove, Chia-Jen Siao, Tina Marinic, Roshelle Clarke, Qian Ma, Deqiang Jing, John J Lafrancois, Kevin G Bath, Willie Mark, Douglas Ballon, Francis S Lee, Helen E Scharfman, Barbara L Hempstead
Experience-dependent plasticity shapes postnatal development of neural circuits, but the mechanisms that refine dendritic arbors, remodel spines, and impair synaptic activity are poorly understood. Mature brain-derived neurotrophic factor (BDNF) modulates neuronal morphology and synaptic plasticity, including long-term potentiation (LTP) via TrkB activation. BDNF is initially translated as proBDNF, which binds p75(NTR). In vitro, recombinant proBDNF modulates neuronal structure and alters hippocampal long-term plasticity, but the actions of endogenously expressed proBDNF are unclear...
May 8, 2014: Cell Reports
Steven R Messé, Michael A Acker, Scott E Kasner, Molly Fanning, Tania Giovannetti, Sarah J Ratcliffe, Michel Bilello, Wilson Y Szeto, Joseph E Bavaria, W Clark Hargrove, Emile R Mohler, Thomas F Floyd
BACKGROUND: The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized. METHODS AND RESULTS: We performed a prospective cohort study of subjects ≥65 years of age who were undergoing AVR for calcific aortic stenosis. Subjects were evaluated by neurologists preoperatively and postoperatively and underwent postoperative magnetic resonance imaging. Over a 4-year period, 196 subjects were enrolled at 2 sites (mean age, 75...
June 3, 2014: Circulation
Prashanth Vallabhajosyula, Tyler J Wallen, Lauren P Solometo, Jeanne Fox, William J Vernick, W Clark Hargrove
OBJECTIVE: To determine operative outcomes of right mini-thoracotomy mitral valve surgery utilizing port access technology in first-time and reoperative cardiac surgery patients. METHODS: From 2002 to 2011, 881 patients underwent minimally invasive mitral valve surgery. Of these, 154 patients had previous cardiac operations via sternotomy (Group 1), of which 18 (12%) had two previous operations. Seven hundred and twenty-seven patients had no previous cardiac operations (Group 2)...
May 2014: Journal of Cardiac Surgery
Martin Misfeld, Michael Borger, John G Byrne, W Randolph Chitwood, Lawrence Cohn, Aubrey Galloway, Jens Garbade, Mattia Glauber, Ernesto Greco, Clark W Hargrove, David M Holzhey, Ralf Krakor, Didier Loulmet, Yugal Mishra, Paul Modi, Douglas Murphy, L Wiley Nifong, Kazuma Okamoto, Joerg Seeburger, David H Tian, Marcel Vollroth, Tristan D Yan
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...
November 2013: Annals of Cardiothoracic Surgery
S Chris Malaisrie, Glenn R Barnhart, R Saeid Farivar, John Mehall, Brian Hummel, Evelio Rodriguez, Mark Anderson, Clifton Lewis, Clark Hargrove, Gorav Ailawadi, Scott Goldman, Junaid Khan, Michael Moront, Eugene Grossi, Eric E Roselli, Arvind Agnihotri, Michael J Mack, J Michael Smith, Vinod H Thourani, Francis G Duhay, Mark T Kocis, William H Ryan
BACKGROUND: Since the first aortic valve replacement through a right thoracotomy was reported in 1993, upper hemisternotomy and right anterior thoracotomy have become the predominant approaches for minimally invasive aortic valve replacement. Clinical studies have documented equivalent operative mortality, less bleeding, and reduced intensive care/hospital stay compared with conventional sternotomy despite longer procedure times. However, comparative trials face challenges due to patient preference, surgeon bias, and the lack of a standardized minimally invasive surgical approach...
January 2014: Journal of Thoracic and Cardiovascular Surgery
Pavan Atluri, Y Joseph Woo, Andrew B Goldstone, Jeanne Fox, Michael A Acker, Wilson Y Szeto, W Clark Hargrove
BACKGROUND: Minimally invasive approaches to mitral valve repair have demonstrated equivalent technical outcomes and more rapid recovery when compared with traditional sternotomy. These techniques have been widely accepted for mitral insufficiency and stenosis. The utilization of minimally invasive techniques in the presence of left ventricular (LV) dysfunction has been controversial. We hypothesized that minimally invasive mitral valve surgery could be safely performed in the presence of compromised myocardial function, thereby minimizing recovery time...
November 2013: Annals of Thoracic Surgery
William J Vernick, E Andrew Ochroch, Jiri Horak, Mary Hammond, W Clark Hargrove
OBJECTIVE: To evaluate the accuracy of Doppler-derived transmitral valve gradients immediately after mitral valve repair by comparing them with near simultaneously obtained direct catheter gradients. DESIGN: A prospective study. SETTING: A tertiary care medical center. PARTICIPANTS: Twenty elective adult surgical patients presenting for mitral valve repair surgery. METHODS: Mitral valve surgery proceeded in standard fashion except for the use of a smaller than usual left ventricular vent catheter (Medtronic DLP 10 French left heart vent catheter)...
July 2013: Journal of Cardiac Surgery
Andrew B Goldstone, Pavan Atluri, Wilson Y Szeto, Alen Trubelja, Jessica L Howard, John W MacArthur, Craig Newcomb, Joseph P Donnelly, Dale M Kobrin, Mary A Sheridan, Christiana Powers, Robert C Gorman, Joseph H Gorman, Alberto Pochettino, Joseph E Bavaria, Michael A Acker, W Clark Hargrove, Y Joseph Woo
OBJECTIVE: Minimally invasive approaches to mitral valve surgery are increasingly used, but the surgical approach must not compromise the clinical outcome for improved cosmesis. We examined the outcomes of mitral repair performed through right minithoracotomy or median sternotomy. METHODS: Between January 2002 and October 2011, 1011 isolated mitral valve repairs were performed in the University of Pennsylvania health system (455 sternotomies, 556 right minithoracotomies)...
March 2013: Journal of Thoracic and Cardiovascular Surgery
W Clark Hargrove
No abstract text is available yet for this article.
March 2012: Annals of Thoracic Surgery
Rachana Sainger, Juan B Grau, Emanuela Branchetti, Paolo Poggio, William F Seefried, Benjamin C Field, Michael A Acker, Robert C Gorman, Joseph H Gorman, Clark W Hargrove, Joseph E Bavaria, Giovanni Ferrari
Myxomatous mitral valve prolapse (MVP) is the most common cardiac valvular abnormality in industrialized countries and a leading cause of mitral valve surgery for isolated mitral regurgitation. The key role of valvular interstitial cells (VICs) during mitral valve development and homeostasis has been recently suggested, however little is known about the molecular pathways leading to MVP. We aim to characterize bone morphogenetic protein 4 (BMP4) as a cellular regulator of mitral VIC activation towards a pathologic synthetic phenotype and to analyze the cellular phenotypic changes and extracellular matrix (ECM) reorganization associated with the development of myxomatous MVP...
June 2012: Journal of Cellular Physiology
William J Vernick, W Clark Hargrove, John G Augoustides, Jiri Horak
Takotsubo cardiomyopathy is increasingly being recognized in the perioperative period. To date, there have been only three previous cases involving cardiac surgery reported and this represents the fourth case. The precise mechanism remains elusive, and there is no definitive management strategy. It appears that the syndromes course in cardiac surgical patients is self-limited. This syndrome must now be considered in the differential diagnosis of postcardiotomy cardiac failure.
November 2010: Journal of Cardiac Surgery
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