Publications by authors named "David Kaczorowski"
Pulmonary Artery Vasa Vasorum Damage in Severe COVID-19-Induced Pulmonary Fibrosis.
Ann Thorac Surg Short Rep
September 2024
Background: COVID-19 patients exhibit higher incidence of thrombosis in arteries and veins, including those in lungs. Vasa vasorum, which support large blood vessels, have shown involvement in these pathologic processes.
Methods: To further explore the extent of microvascular damage caused by COVID-19 infection, we examined resected main, right, or left pulmonary artery specimens from patients undergoing bilateral lung transplantation for COVID-19- or non-COVID-19-induced pulmonary fibrosis compared with organ donors by histologic and immunohistologic analyses.
Intraoperative Features Improve Model Risk Predictions After Coronary Artery Bypass Grafting.
Ann Thorac Surg Short Rep
September 2024
Background: Intraoperative physiologic parameters could offer predictive utility in evaluating risk of adverse postoperative events yet are not included in current standard risk models. This study examined whether the inclusion of continuous intraoperative data improved machine learning model predictions for multiple outcomes after coronary artery bypass grafting, including 30-day mortality, renal failure, reoperation, prolonged ventilation, and combined morbidity and mortality (MM).
Methods: The Society of Thoracic Surgeons (STS) database features and risk scores were combined with retrospectively gathered continuous intraoperative data from patients.
Background: There has been a significant increase in the utilization of non-mechanical valves in the aortic position over time. However, details in reinterventions after aortic root replacement (ARR) with non-mechanical prosthesis were limited in the literature, despite the potential importance of reinterventions in the lifetime management of aortic valve disease.
Methods: This is a single-center retrospective study, identifying all patients who underwent ARR with allograft, xenografts, and stented bioprosthetic valved conduit from 2010 to 2020.
Objective: Elderly patients are less likely to undergo surgery for an acute type A aortic dissection (ATAAD). This study aims to understand the risks of surgical treatment in patients 75 and older.
Methods: This was a retrospective study using an institutional database of patients who underwent ATAAD repair from 2007 to 2021.
Background: Traditional decannulation of femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) involves femoral cutdown. Percutaneous methods have been developed, but data supporting their use is limited. We sought to compare the MANTA vascular closure device to open decannulation.
View Article and Find Full Text PDFBackground: We sought to assess the effect of postoperative renal failure (RF) on outcomes of acute type A aortic dissection (ATAAD) and identify predictors of chronic kidney disease (CKD) following ATAAD.
Methods: This retrospective single-center analysis included all adults with ATAAD from 2011 to 2023. Patients were stratified into RF and no RF groups.
Article Synopsis
- The UNOS 2018 heart allocation policy prioritizes patients on temporary mechanical circulatory support (tMCS) due to their high risk of mortality while waiting for a heart transplant.
- A study analyzed 27,343 adults on the waitlist and found a significant increase in tMCS use from 7.4% to 22.4% after the policy change.
- Results showed that patients on tMCS had lower waitlist mortality, higher chances of receiving a transplant, and similar one-year mortality rates after transplantation compared to previous trends.
Article Synopsis
- - The study investigates how donor cardiopulmonary resuscitation (CPR) status affects the outcomes of heart transplants from donors after circulatory death (DCD).
- - An analysis of 683 adult DCD heart transplant recipients showed that those who received donor hearts from CPR donors had similar 1-year survival rates (around 92%) as those from non-CPR donors.
- - Results indicate that using DCD hearts from donors who underwent CPR can help increase the availability of donor organs without harming initial post-transplant survival rates.
Background: This study evaluates the impact of the agonal phase and related hemodynamic measures on post-transplant outcomes and heart utilization in donation after circulatory death (DCD) heart transplantation.
Methods: United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation between January 1, 2019 and September 30, 2023. The recipients were stratified into 2 groups based on donor agonal period: <30 and ≥30 minutes.
Article Synopsis
- The study aimed to evaluate the impact of hospital teaching status on outcomes for patients with type B aortic dissection (TBAD) using data from the National Readmissions Database over four years.
- A total of 44,981 TBAD patients were analyzed, revealing no significant differences in in-hospital mortality or 30-day readmission rates between those treated at teaching hospitals versus non-teaching hospitals.
- At teaching hospitals, the use of thoracic endovascular aortic repair (TEVAR) showed higher risks of in-hospital mortality, while higher hospital patient volumes were linked to increased chances of 30-day readmissions.
Article Synopsis
- The study aimed to assess how intraoperative neuromonitoring (IONM) affects the risk of stroke and mortality during coronary and valvular heart operations over a period of 11 years.
- Out of 19,299 patients, 589 (3.1%) received IONM, and those patients had higher pre-existing cerebrovascular diseases, resulting in increased rates of operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%).
- However, after adjusting for patient characteristics, there was no significant difference in stroke or mortality rates between IONM users and non-users, suggesting that IONM may indicate risks rather than directly influence outcomes.
Article Synopsis
- The study investigates the occurrence of subcutaneous emphysema (SE) after robotic cardiac surgery, analyzing data from 116 patients who underwent various procedures.
- SE was found in 45.7% of patients, with most cases being mild; however, severe cases required additional medical intervention like CT scans and chest tubes.
- Factors such as low body weight, low BMI, small body surface area, and older age are linked to a higher incidence of SE, particularly in those undergoing robotic mitral valve repair compared to other robotic surgeries.
Article Synopsis
- The study aimed to determine if using epiaortic ultrasound to assess aortic calcification would lower the rate of postoperative strokes in patients undergoing coronary artery bypass grafting (CABG).
- A total of 10,049 patients were analyzed, with 1,572 receiving epiaortic ultrasound. The results showed no significant difference in stroke rates between the groups, with 0.8% in the ultrasound group and 1.4% in the non-ultrasound group.
- Overall, the study concluded that epiaortic ultrasound did not significantly reduce the odds of postoperative stroke or hazards of mortality in CABG patients.
Background: This study evaluates the effects of pre-transplant transpulmonary gradient (TPG) and donor right ventricular mass (RVM) on outcomes following heart transplantation.
Methods: UNOS registry was queried to analyze adult recipients who underwent primary isolated heart transplantation from 1/1/2010 to 12/31/2018. The recipients were dichotomized into 2 groups based on their TPG at the time of transplantation, < 12 and ≥ 12 mmHg.
Objective: We created and validated a low-cost simulation model for robotic internal mammary artery (IMA) takedown.
Methods: The simulation model utilized a calf fetus thorax cavity stented open internally and secured to a table. The simulation model was validated at a 2-day robotic cardiac surgery workshop.
Background: This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.
Methods: The United Network for Organ Sharing registry was queried to identify adult waitlisted and transplanted patients from January 1, 2015, to December 31, 2022. In the waitlist analysis, the candidates were stratified into 2 cohorts based on whether they were willing to accept HCV+ donor offers.
Background: This study evaluates the interaction of donor and recipient age with outcomes following heart transplantation under the 2018 heart allocation system.
Methods: The United Network for Organ Sharing registry was queried to analyze adult primary isolated orthotopic heart transplant recipients and associated donors from August 18, 2018, to June 30, 2021. Both recipient and donor cohorts were grouped according to age: <65 and ≥65 y for recipients and <50 and ≥50 y for donors.
Article Synopsis
- Persistent acute kidney injury (pAKI) has a worse prognosis than transient acute kidney injury (AKI) in critically ill patients, but its impact and definitions are less understood in organ transplant recipients.
- A systematic review of 25 studies involving 6,330 patients showed a wide variation in the incidence and definitions of pAKI among heart, lung, and liver transplant recipients.
- pAKI is linked to higher rates of new chronic kidney disease, graft dysfunction, and long-term mortality, highlighting the need for standardized definitions in future research.
Prior studies assessing the effects of Impella 5.5 support duration on posttransplant outcomes have been limited to single-center case reports and series. This study evaluates the impact of Impella 5.
View Article and Find Full Text PDFBackground: Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed.
Methods: Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons' Intermacs registry were studied.
Background: This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.
Methods: The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist.
Article Synopsis
- The study compares outcomes of bioprosthetic versus mechanical valves in older patients who had surgical aortic valve replacement (SAVR), using data from 1,847 patients over a follow-up period of 6.2 years.
- It found no significant differences in early survival between valve types across age groups, but younger patients (<65 years) with bioprosthetic valves faced higher reintervention rates compared to those with mechanical valves.
- The study indicates that bioprosthetic valves are associated with a significantly higher risk of needing repeat aortic valve surgery in younger patients, highlighting the need for better validation of valve type recommendations for different age groups.
In light of ongoing shortage of donor organs for transplantation, alternative sources for donor organ sources have been examined to address this supply-demand mismatch. Of these, xenotransplantation, or the transplantation of organs across species, has been considered, with early applications dating back to the 1600s. The purpose of this review is to summarize the early experiences of xenotransplantation, with special focus on heart xenotransplantation.
View Article and Find Full Text PDFRobotically assisted outflow graft anastomosis in minimally invasive left-ventricular assist device implantation: feasibility, surgeon comfort, and operative times in an anatomical study.
J Robot Surg
June 2024
Upper hemi-sternotomy is a common approach for outflow graft anastomosis to the ascending aorta in minimally invasive left-ventricular assist device implantation. Right mini-thoracotomy may also be used, but use of robotic assistance has been reported only anecdotally. The aim of our study was to confirm the feasibility of robotically assisted suturing of the outflow graft anastomosis and to assess performance metrics for the robotic suturing part of the procedure.
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