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Dermot Phelan, Brett W Sperry, Paaladinesh Thavendiranathan, Patrick Collier, Zoran B Popović, Harry M Lever, Nicholas G Smedira, Milind Y Desai
Accurate and reproducible quantification of ventricular septal (VS) thickness in hypertrophic cardiomyopathy (HC) is essential for diagnosis, surgical planning, and risk stratification. We sought to compare VS thickness measurements using transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance (CMR) in patients with HC. Prospectively reported measurements of VS thickness were compared using analysis of variance and Bland-Altman plots in 90 consecutive patients with HC who underwent a TTE, TEE, and CMR within 3 months...
March 1, 2017: American Journal of Cardiology
Barry J Maron, Joseph A Dearani, Martin S Maron, Steve R Ommen, Hassan Rastegar, Rick A Nishimura, Daniel G Swistel, Mark V Sherrid, Anthony Ralph-Edwards, Harry Rakowski, Nicholas G Smedira, Ethan J Rowin, Milind Y Desai, Harry M Lever, Paolo Spirito, Paolo Ferrazzi, Hartzell V Schaff
No abstract text is available yet for this article.
February 1, 2017: Journal of Thoracic and Cardiovascular Surgery
Ahmad Masri, Mohamed Kanj, Maran Thamilarasan, Oussama Wazni, Nicholas G Smedira, Harry M Lever, Milind Y Desai
BACKGROUND: Atrial fibrillation (AF) is a frequent occurrence in patients with hypertrophic cardiomyopathy (HCM). It is associated with worsening symptoms, cardiovascular events, and mortality. We conducted a meta-analysis of studies reporting on mortality in patient with HCM and AF. METHODS: We searched PubMed, Medline, Embase, Ovid and Cochrane for studies which reported cardiovascular events and mortality in patients with HCM and AF. Outcome was a composite of cardiac mortality and/or all-cause mortality...
February 2017: Cardiovascular Diagnosis and Therapy
Abraham Sonny, Shiva Sale, Nicholas G Smedira
No abstract text is available yet for this article.
September 7, 2016: Anesthesia and Analgesia
Lars G Svensson, Saila T Pillai, Jeevanantham Rajeswaran, Milind Y Desai, Brian Griffin, Richard Grimm, Donald F Hammer, Maran Thamilarasan, Eric E Roselli, Gösta B Pettersson, A Marc Gillinov, Jose L Navia, Nicholas G Smedira, Joseph F Sabik, Bruce W Lytle, Eugene H Blackstone
OBJECTIVE: To evaluate long-term results of aortic root procedures combined with ascending aorta replacement for aneurysms, using 4 surgical strategies. METHODS: From January 1995 to January 2011, 957 patients underwent 1 of 4 aortic root procedures: valve preservation (remodeling or modified reimplantation, n = 261); composite biologic graft (n = 297); composite mechanical graft (n = 156); or allograft root (n = 243). RESULTS: Seven deaths occurred (0...
March 2016: Journal of Thoracic and Cardiovascular Surgery
Nicholas G Smedira
No abstract text is available yet for this article.
January 2016: Journal of Thoracic and Cardiovascular Surgery
Nicholas G Smedira, Eugene H Blackstone, John Ehrlinger, Lucy Thuita, Christopher D Pierce, Nader Moazami, Randall C Starling
BACKGROUND: Data from 3 institutions revealed an abrupt increase in HeartMate II (Thoratec) pump thrombosis starting in 2011, associated with 48% mortality at 6 months without transplantation or pump exchange. We sought to discover if the increase occurred nationwide in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) data, and if so (1) determine if accelerated risk continued, (2) identify predictors, (3) investigate institutional variability, and (4) assess mortality after pump thrombosis...
December 2015: Journal of Heart and Lung Transplantation
Jay J Idrees, Nicholas K Schiltz, Douglas R Johnston, Stephanie Mick, Nicholas G Smedira, Joseph F Sabik, Eugene H Blackstone, Lars G Svensson, Edward G Soltesz
BACKGROUND: Postoperative stroke is a devastating complication after aortic valve replacement (AVR). Our objective was to use a large national database to identify the incidence of and risk factors for stroke after AVR, as well as to determine incremental mortality, resource use, and cost of stroke. METHODS: We identified 360,437 patients who underwent isolated surgical AVR between 1998 and 2011 from the National Inpatient Sample (NIH) database. Mean age was 66 ± 32 years...
March 2016: Annals of Thoracic Surgery
Marijan Koprivanac, Marta Kelava, Edward Soltesz, Nicholas Smedira, Samir Kapadia, Anna Brzezinski, Shehab Alansari, Nader Moazami
Mechanical circulatory support devices are the mainstay of treatment for severe cardiogenic shock refractory to pharmacologic therapy. Their evolution over the past few decades has been remarkable with a common theme of developing reliable, less bulky and more easily percutaneously implantable devices. The goal of this article is to review existing devices and advances in technology and provide insight into direction of further research and evolution of mechanical circulatory support devices for temporary support...
2015: Expert Review of Medical Devices
Patrick R Vargo, Nicholas K Schiltz, Douglas R Johnston, Nicholas G Smedira, Nader Moazami, Eugene H Blackstone, Edward G Soltesz
A growing number of solid organ transplant survivors require surgery for cardiac disease. We examined the effect of having a previous transplant on outcomes after cardiac surgery in these patients from a population-based perspective. Of 1,709,735 patients who underwent coronary artery bypass grafting, valve, or thoracic aorta surgery from 2004 to 2008 in the Nationwide Inpatient Sample, 3,535 patients (0.21%) had a previous organ transplant (2,712 kidney, 738 liver, 300 pancreas). Multivariate logistic regression analysis and propensity score matching were used to determine the effect of a previous solid organ transplant on outcomes...
December 15, 2015: American Journal of Cardiology
Nicholas G Smedira
No abstract text is available yet for this article.
January 2016: Journal of Thoracic and Cardiovascular Surgery
Milind Y Desai, Nicholas G Smedira, Aditya Bhonsale, Maran Thamilarasan, Bruce W Lytle, Harry M Lever
OBJECTIVES: We sought to assess the long-term outcomes in patients with hypertrophic cardiomyopathy and severe left ventricular outflow tract obstruction, in whom the decision regarding surgery (vs conservative management) was based on assessment of symptoms or exercise capacity. METHODS: This was an observational study of 1530 patients with hypertrophic cardiomyopathy (aged 50 ± 13 years, 63% were men) with severe left ventricular outflow tract obstruction (excluding those aged <18 years, with left ventricular ejection fraction <50%, and with left ventricular outflow tract gradient <30 mm Hg)...
October 2015: Journal of Thoracic and Cardiovascular Surgery
Michael Z Tong, Nicholas G Smedira, Edward G Soltesz, Randall C Starling, Christine E Koval, Liane Porepa, Nader Moazami
BACKGROUND: Left ventricular assist device (LVAD) infections including drivelines, pump pockets, and bacteremia are difficult to manage and conservative treatments may not be effective as the infected foreign material remains. METHODS: We performed a retrospective analysis of all 170 HeartMate II (Thoratec, Pleasanton, CA) implantations as bridge to transplant (BTT) between 2004 and 2012 at our institution. Sixty-one patients (36%) developed a culture positive driveline infection, pump pocket infection, bacteremia, or a combination of these...
October 2015: Annals of Thoracic Surgery
Parag Patel, Ashwat Dhillon, Zoran B Popovic, Nicholas G Smedira, Jessica Rizzo, Maran Thamilarasan, Deborah Agler, Bruce W Lytle, Harry M Lever, Milind Y Desai
BACKGROUND: In patients with hypertrophic cardiomyopathy and left ventricular outflow tract (LVOT) obstruction, but without basal septal hypertrophy, we sought to identify mitral valve (MV) and papillary muscle (PM) abnormalities that predisposed to LVOT obstruction, using echo and cardiac magnetic resonance. METHODS AND RESULTS: We studied 121 patients with hypertrophic cardiomyopathy hypertrophic cardiomyopathy (age, 49±17 years; 60% men; 57% on β-blockers) with a basal septal thickness of ≤1...
July 2015: Circulation. Cardiovascular Imaging
Nicholas G Smedira
No abstract text is available yet for this article.
July 2015: Journal of Thoracic and Cardiovascular Surgery
Alexander Kantorovich, Jodie M Fink, Michael A Militello, Matthew R Wanek, Nicholas G Smedira, Edward G Soltesz, Nader Moazami
BACKGROUND: Anticoagulation with warfarin is common in patients presenting for heart transplant. Prior to surgery, anticoagulation reversal is necessary to avoid significant intraoperative and perioperative bleeding complications. Commonly, warfarin reversal is achieved with vitamin K and fresh frozen plasma (FFP); however, these therapies have significant limitations. An alternative to FFP for reversal exists with prothrombin complex concentrate (PCC). A warfarin reversal protocol prior to heart transplant was implemented using low-dose PCC at our institution...
August 2015: Annals of Pharmacotherapy
Ahmad Masri, Lee M Pierson, Nicholas G Smedira, Shikhar Agarwal, Bruce W Lytle, Peyman Naji, Maran Thamilarasan, Harry M Lever, Leslie S Cho, Milind Y Desai
BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) have exercise intolerance due to left ventricular outflow tract (LVOT) obstruction, mitral regurgitation, and left ventricular dysfunction. We sought to study predictors of outcomes in HCM patients undergoing cardiopulmonary stress testing (CPT). METHODS: We studied 1,005 HCM patients (50 ± 14 years, 64% men, 77% on β-blockers) who underwent CPT with echocardiography. Clinical, echocardiographic, and exercise variables (peak oxygen consumption [VO2] and heart rate recovery [HRR] at first minute postexercise) were recorded...
May 2015: American Heart Journal
Mohamed Bassiouny, Bruce D Lindsay, Harry Lever, Walid Saliba, Allan Klein, Moustafa Banna, JoEllyn Abraham, Mingyuan Shao, John Rickard, Mohamed Kanj, Patrick Tchou, Thomas Dresing, Bryan Baranowski, Mandeep Bhargava, Thomas Callahan, Khaldoun Tarakji, Daniel Cantillon, Ayman Hussein, A Marc Gillinov, Nicholas G Smedira, Oussama Wazni
BACKGROUND: Limited data exist regarding the outcome of atrial fibrillation (AF) surgery and catheter ablation in patients with hypertrophic cardiomyopathy (HCM). OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of nonpharmacologic treatment of AF in HCM. METHODS: One hundred forty-seven patients (46 female, age 55 ± 11 years, ejection fraction [EF] 58% ± 8%) with symptomatic paroxysmal (58%), persistent (31%), and long-standing persistent AF (11%) refractory to antiarrhythmic drugs who presented for their first catheter ablation (n = 79) or AF surgery (n = 68) were included...
July 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Srisakul Chirakarnjanakorn, Zoran B Popović, Willis Wu, Ahmad Masri, Nicholas G Smedira, Bruce W Lytle, Brian P Griffin, Milind Y Desai
BACKGROUND: Malignancy-associated thoracic radiation leads to radiation-associated cardiac disease (RACD) that often necessitates cardiac surgery. Myocardial dysfunction is common in patients with RACD. We sought to determine the predictive value of global left ventricular ejection fraction and long-axis function left ventricular global longitudinal strain (LV-GLS) in such patients. METHODS: We studied 163 patients (age, 63 ± 14 years; 74% women) who had RACD and underwent cardiac surgery (20% had reoperations) between 2000 and 2003...
June 2015: Journal of Thoracic and Cardiovascular Surgery
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