Emergent TandemHeart-ECMO for acute severe mitral regurgitation with cardiogenic shock and hypoxaemia: a case series.

Background: Acute severe mitral regurgitation (MR) associated with cardiogenic shock is a life-threatening emergency. Traditional teaching has focused on the need for emergent coronary angiography and/or intra-aortic balloon counterpulsation in preparation for emergent open-heart surgery for repair/replacement. Unfortunately, emergent open-heart surgery in patients with acute MR complicated by cardiogenic shock is associated with 25-46% perioperative mortality.

Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers in direct admissions and transfers.

Background: The purpose of this study is (1) to define the proportion of patients undergoing emergent open repair of thoracic aortic dissection admitted directly through the emergency room versus those transferred from outside hospitals and (2) to determine if a volume-outcomes relationship exists for those patients across admission types.

Methods: De-identified patient-level data was obtained from the Nationwide Inpatient Sample (2004-2008). Patients undergoing emergent aortic surgery for thoracic aortic dissection (n = 1,507) were identified by ICD-9 codes and stratified by annual center volume into low volume (≤5 cases/year) (n = 963; 63.

Successful Management of Thrombosis of the Proximal Aorta after Implantation with a Biventricular Assist Device.

Continuous-flow ventricular assist devices (CVADs) are associated with a significant complication profile that includes thrombosis of the ascending aorta and aortic valve, thromboembolism, and stroke. Despite an increasing number of reports of thromboembolic complications related to CVADs, there is little in the literature to guide their management. This report describes successful management strategies used during two cases of thrombosis of the ascending aorta during biventricular CentriMag (Levitronix LLC, Waltham, MA) support, including using pre-existing cannulas to initiate cardiopulmonary bypass.

The impact of age and severity of comorbid illness on outcomes after isolated aortic valve replacement for aortic stenosis.

Objectives: This study examines outcomes in a national sample of patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis, with particular focus on advanced-age patients and those with extreme severity of comorbid illness (SOI).

Methods: Data were obtained from the Nationwide Inpatient Sample and included all patients undergoing AVRs performed from January 1, 2006 to December 31, 2008. Patients with major concomitant cardiac procedures, as well as those aged, 20 years, and those with infective endocarditis or aortic insufficiency without aortic stenosis, were excluded from analysis.

Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers.

Background: Previous studies have demonstrated that patients undergoing complex surgical procedures at high-volume centers have improved outcomes. The goal of this study was to determine if this volume-outcomes relationship persists at a national level among patients undergoing emergent open repair for thoracic aortic dissection.

Methods: De-identified patient-level data were obtained from the Nationwide Inpatient Sample (2005 to 2008).

Stingray barb injury: a cause of late coronary occlusion and stent failure.

Stingray injuries to the heart are rare, and survivors of this injury are even rarer. To date, there are only three reported survivors of this mode of penetrating cardiac injury, all inflicted by the living animal itself. The following is a report of a stingray injury, inflicted by a human, causing coronary complications 17 years after the injury was sustained.

Kernel regression for fMRI pattern prediction.

This paper introduces two kernel-based regression schemes to decode or predict brain states from functional brain scans as part of the Pittsburgh Brain Activity Interpretation Competition (PBAIC) 2007, in which our team was awarded first place. Our procedure involved image realignment, spatial smoothing, detrending of low-frequency drifts, and application of multivariate linear and non-linear kernel regression methods: namely kernel ridge regression (KRR) and relevance vector regression (RVR). RVR is based on a Bayesian framework, which automatically determines a sparse solution through maximization of marginal likelihood.

Multivessel off-pump revascularization in patients with significant left main coronary artery stenosis: early and midterm outcome analysis.

Background: The presence of significant left main stenosis (> or =50%) has been considered a relative contraindication to the use of off-pump coronary artery bypass (OPCAB) stemming from well-documented hemodynamic perturbations during the displacement of the heart. We examined our experience with patients with critical left main stenosis (LMS) to assess the safety and feasibility of OPCAB in this subgroup.

Methods: Our prospectively updated database was queried to identify all patients with severe left main disease who underwent isolated coronary revascularization between January 1, 1999 and May 31, 2002.

Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?

Background: Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on the incidence of postoperative renal failure and survival of patients with preexisting renal dysfunction.

Multivessel off-pump revascularization in patients with severe left ventricular dysfunction.

Objective: The purpose of this study was to investigate the safety and efficacy of multivessel beating heart revascularization in a high-risk group of patients with severe left ventricular dysfunction as well as to provide intermediate survival and quality of life data.

Methods: Our prospectively updated database was queried to extract all patients with left ventricular ejection fraction < or =30% who underwent beating heart revascularization. Standard demographics, clinical profiles and outcomes were collected.

Multivessel off-pump revascularization in octogenarians: early and midterm outcomes.

Background: Octogenarians are increasingly being referred for coronary artery revascularization. However, the prevalence of comorbid events and the propensity for neurologic dysfunction place octogenarians at higher risk for cardiopulmonary bypass-induced morbidity and mortality. Therefore, octogenarian patients represent a particularly attractive target for application of off-pump coronary artery bypass grafting.