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Albree Tower-Rader, Jorge Betancor, Zoran B Popovic, Kimi Sato, Maran Thamilarasan, Nicholas G Smedira, Harry M Lever, Milind Y Desai
BACKGROUND: In obstructive hypertrophic cardiomyopathy patients with preserved left ventricular (LV) ejection fraction, we sought to determine whether LV global longitudinal strain (LV-GLS) provided incremental prognostic utility. METHODS AND RESULTS: We studied 1019 patients with documented hypertrophic cardiomyopathy (mean age, 50±12 years; 63% men) evaluated at our center between 2001 and 2011. We excluded age <18 years, maximal LV outflow tract gradient <30 mm Hg, bundle branch block or atrial fibrillation, past pacemaker/cardiac surgery, including myectomy/alcohol ablation, and obstructive coronary artery disease...
October 20, 2017: Journal of the American Heart Association
Tamer Attia, Michael Robich, A Michael Lincoff, Mehdi H Shishehbor, Lars Svensson, Nicholas G Smedira
Acute Type A aortic dissection is a surgical emergency. Urgent repair is indicated to avoid complications such as acute aortic insufficiency, coronary ischemia and aortic rupture with cardiac tamponade. This report details the management of a patient with acute Type A aortic dissection complicated by an extensive anterolateral myocardial infarction and cardiogenic shock who was successfully bridged to transplantation with a total artificial heart.
August 2017: Journal of Surgical Case Reports
Vickram Tejwani, Karunakaravel Karuppasamy, Marcelo P Gomes, Abraham Levitin, James M Luethke, Christopher J Morin, Nicholas G Smedira, Gustavo A Heresi, Wayne F Yakes
Venous malformations have static venous lakes that predispose to spontaneous venous thrombosis within the malformation due to its low-flow static state. Thrombi of varying sizes can then embolize continually into the pulmonary arterial circulation, and occlude and narrow elastic pulmonary arteries causing chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary thromboendarterectomy (PTE) is potentially curative in CTEPH, but has not been previously reported in the setting of mediastinal and chest wall venous malformations...
March 2017: Pulmonary Circulation
Robert J Steffen, Eugene H Blackstone, Nicholas G Smedira, Edward G Soltesz, Katherine J Hoercher, Lucy Thuita, Randall C Starling, Maria Mountis, Nader Moazami
BACKGROUND: Optimal timing of heart transplantation in patients supported with second-generation left ventricular assist devices (LVADs) is unknown. Despite this, patients with LVADs continue to receive priority on the heart transplant waiting list. Our objective was to determine the optimal timing of transplantation for patients bridged with continuous-flow LVADs. METHODS: A total of 301 HeartMate II LVADs (Thoratec Corp, Pleasanton, CA) were implanted in 285 patients from October 2004 to June 2013, and 86 patients underwent transplantation through the end of follow-up...
November 2017: Annals of Thoracic Surgery
Brandon M Jones, Amar Krishnaswamy, Nicholas G Smedira, Milind Y Desai, E Murat Tuzcu, Samir R Kapadia
No abstract text is available yet for this article.
May 16, 2017: Journal of the American Heart Association
Eoin Donnellan, Ahmad Masri, Douglas R Johnston, Gosta B Pettersson, L Leonardo Rodriguez, Zoran B Popovic, Eric E Roselli, Nicholas G Smedira, Lars G Svensson, Brian P Griffin, Milind Y Desai
BACKGROUND: Cardiac disease after mediastinal radiotherapy for thoracic malignancy (chest radiotherapy [XRT]) often manifests as progressive aortic stenosis. In patients with XRT-induced severe aortic stenosis undergoing surgical aortic valve replacement (SAVR), we sought to: (1) study long-term survival and compare these patients with a matched cohort undergoing SAVR during the same time frame; and (2) identify potential predictors of long-term mortality. METHODS AND RESULTS: We studied patients with symptomatic severe aortic stenosis undergoing SAVR at our institution, of which there were 172 mediastinal XRT patients (63±13 years, 62% women) matched in a 1:1 fashion (based on age, sex, time of surgery, and aortic valve area) with 172 non-XRT patients (comparison group)...
May 5, 2017: Journal of the American Heart Association
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...
May 15, 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.
November 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
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