Publications by authors named "Dearani J"
Objective: Giant cell arteritis (GCA) may present as proximal aortic pathology requiring surgical intervention. We present our experience with surgical management of GCA in patients presenting with proximal aortic disease.
Methods: From January 1993 to May 2020, 184 adult patients were diagnosed with GCA on histopathology after undergoing cardiac surgery.
Objectives: Robotic-assisted mitral valve repair (MVr) is a well-established procedure for management of degenerative mitral valve disease. Limited data regarding concomitant robotic-assisted tricuspid valve repair (TVr) is available. This review investigates prevalence and outcomes of concomitant robotic-assisted mitral and tricuspid valve repair.
View Article and Find Full Text PDFObjective: To study the effectiveness of virtual reality (VR) in reducing anxiety levels in patients undergoing first-time sternotomy for cardiac surgery.
Patients And Methods: A total of 100 adult patients scheduled for cardiac surgery at Mayo Clinic in Rochester, Minnesota, USA, was recruited from April 19, 2022, to October 12, 2022. Before surgery, patients wore a physiological monitor to record vital signs.
Background: This study sought to evaluate short- and long-term outcomes of aortic valve (AV) intervention by decalcification or replacement for the treatment of mild to moderate calcific AV stenosis (AS) in patients undergoing transaortic septal myectomy for subaortic left ventricular outflow tract (LVOT) obstruction.
Methods: Between 2000 and 2023, study investigators identified 137 consecutive patients undergoing myectomy with or without membranectomy for mild to moderate calcific AS. Of these patients, 93 underwent surgical intervention on the AV and formed the primary cohort; 44 patients who did not undergo AV intervention were used as a control group.
Article Synopsis
- Ascending-to-descending aortic bypass is a repair method for complex aortic coarctation, showing low early complications, but long-term results were previously unclear.
- A study of 81 patients who had the procedure from 1985 to 2012 revealed 5, 10, and 20-year survival rates of 94%, 90%, and 85%, with no perioperative deaths and no significant complications related to the bypass.
- Overall, this technique is considered safe with excellent long-term outcomes, improving systemic hypertension, and does not interfere with future surgeries through the same chest incision.
A Rare Case of Solitary Cardiac Myofibroma in an Infant.
World J Pediatr Congenit Heart Surg
January 2025
Article Synopsis
- Solitary myofibromas are rare, benign tumors mostly found in the head and neck, but this report focuses on an unusual case of a solitary cardiac myofibroma in an infant.
- A two-month-old was diagnosed with a 2×1 cm mass on the mitral papillary muscle, leading to severe heart regurgitation; imaging techniques were used to assess the mass.
- Surgical removal was performed and the patient recovered well, with follow-up showing no recurrence of the tumor and minor regurgitation issues.
Noonan syndrome (NS) is a predominantly autosomal dominant condition with various cardiac and extra-cardiac manifestations. Although it has been linked with atrial arrhythmias, ventricular arrhythmias are extremely rare in the absence of underlying structural cardiac abnormalities. We report an instance of aborted sudden cardiac arrest in a 7-year-old male with a confirmed SOS1 variant and a lack of evidence to support a structural cardiac, metabolic, or infectious etiology.
View Article and Find Full Text PDFBackground: Middle-aged Fontan patients are underrepresented in contemporary studies. The purpose of this study was to describe the clinical characteristics and outcomes in middle-aged patients with Fontan palliation.
Methods: All adults with Fontan palliation were divided into 'middle-aged' group (>40 years of age at baseline encounter), and 'young adult' group.
Article Synopsis
- Surgical septal reduction is often considered risky in older adults, but this study evaluates the differences between younger and older patients undergoing septal myectomy for obstructive hypertrophic cardiomyopathy (oHCM).
- The study analyzed 2,663 patients over 21 years and found that older patients (65+) had higher rates of health issues like hypertension and diabetes, yet similar functional limitations when compared to younger counterparts.
- Despite some increased risks, septal myectomy is deemed safe for older patients, with a notable link between left ventricular wall asymmetry and poorer prognosis in this age group.
Article Synopsis
- The study investigates how the timing of coronary artery bypass grafting (CABG) after an acute heart attack affects patient outcomes, focusing on both early and long-term mortality rates.
- Researchers analyzed data from 1,631 patients who had CABG, categorizing them based on whether surgery was performed within 24 hours, between 1 to 7 days, or more than 7 days post-heart attack.
- Results showed that while early mortality rates were similar across timing groups, those who had CABG more than 7 days after an attack faced significantly higher risks of late mortality, particularly in patients with non-ST-segment elevation myocardial infarction.
Article Synopsis
- Patients with hypertrophic cardiomyopathy (HCM) frequently experience cardiac arrhythmias and often require cardiac implantable electronic devices (CIED), which can lead to complications like tricuspid regurgitation (TR) needing surgery.
- In a study of 21 patients who had tricuspid valve (TV) surgery for device lead-induced TR after undergoing septal myectomy (SM) for HCM, the majority had severe TR and associated symptoms of right heart failure.
- Results showed that while the immediate surgical outcomes were acceptable, long-term survival for these patients was significantly lower (58% at 5 years) compared to other patients who had undergone SM (96%).
Article Synopsis
- * The study analyzed tissues from 97 patients with symptomatic obstructive HCM through RNA-sequencing and mass spectrometry, revealing significant differences in gene and protein expressions between males and females, though overall profiles were similar.
- * Findings indicate that HCM females show greater downregulation of hypertrophy pathways and have more differentially expressed proteins compared to control females than what is observed in males, highlighting biologically relevant sex-specific differences in disease mechanisms.
Background: The purpose of this review is to provide recommendations for cardiac surgeons interested in adopting a robotic platform into their programs.
Methods: The recommendations are based on the experience of the authors and cover a diverse array of cardiac surgical procedures that are currently performed with robotic assistance. The focus, as with any innovative surgical approach, is to ensure patient safety, maximize quality and efficacy, and set realistic expectations about what is required to achieve proficiency in robotic cardiac surgery.
Article Synopsis
- The study aimed to explore the health outcomes and factors relating to adults with a specific heart condition called partial anomalous pulmonary venous return with an intact atrial septum (PAPVR-IAS) that hasn't been surgically repaired.
- Researchers at the Mayo Clinic analyzed various clinical indicators and heart measurements in 80 patients over 3 to 5 years, comparing those with unrepaired PAPVR-IAS to those who underwent repair.
- They found that a newly developed risk score could predict the need for surgical intervention, and importantly, patients with unrepaired PAPVR-IAS showed no significant decline in their health or heart function over time.
Article Synopsis
- The study examines the occurrence of cardiac myxomas in patients with Carney complex (CNC) over a time span from 1970 to 2023, identifying 38 patients in total.
- Out of these, 24 patients (63.1%) developed cardiac myxomas, with a median onset age of 39 years, and more than half (54.1%) experienced recurrences post-surgery.
- The findings highlight the importance of regular echocardiogram monitoring for CNC patients, as surgical removal is crucial for managing these myxomas effectively.
Article Synopsis
- Limited data exist regarding the effects of cardiac surgery on pregnant individuals and their fetuses, prompting a study reviewing cases from 1978 to 2023.
- The study analyzed 29 pregnant patients undergoing cardiac surgery, revealing a maternal death rate of 3% and a fetal loss rate of 17%, with higher mortality in those undergoing surgery later in pregnancy.
- The findings suggest that cesarean delivery before surgery may help reduce fetal mortality if the fetus is viable, highlighting the need for careful planning in such cases.
Article Synopsis
- The study analyzed over 148,000 coronary artery bypass grafting (CABG) cases to assess risks associated with clopidogrel (a blood thinner) taken within 5 days prior to surgery.
- It found that patients who had used clopidogrel had slightly higher operative mortality and significantly higher rates of mediastinal reexploration for bleeding and blood product use compared to those who hadn't taken the drug.
- The risks decreased the longer the wait after stopping clopidogrel, reaching similar outcomes for surgeries performed 3 days after the last dose compared to 5 days, suggesting 3 days may be a sufficient waiting period before CABG.
PA-VSD Without MAPCA(s): Review of Long-Term Outcomes and Reinterventions.
World J Pediatr Congenit Heart Surg
July 2024
Article Synopsis
- Pulmonary atresia with ventricular septal defect (VSD) without major aortopulmonary collateral arteries (MAPCAs) is a rare congenital heart defect, with the study focusing on long-term outcomes as more patients reach adulthood.
- A review of studies from 1990 to now revealed that around 80% of patients survive ten years, and factors like complete repair and the size of pulmonary arteries significantly improve survival rates.
- Long-term challenges include the need for additional procedures on the right ventricular outflow tract, particularly if the pulmonary arteries are underdeveloped or if the initial repair was incomplete.
Article Synopsis
- Patients with congenital heart disease often require reoperative surgeries, especially for valve issues, and a study tracked 1960 adult patients undergoing repeat surgeries from 1993 to 2022 to analyze outcomes.* -
- Among the 502 patients studied, most underwent surgeries involving multiple valves, with low early mortality rates of 4.2%, particularly for elective operations.* -
- Key factors influencing mortality included patient age, heart function, and the urgency of the surgery, indicating that timely referrals can improve surgical outcomes.*
Objective: The selection of valve prostheses for patients undergoing surgical aortic valve replacement remains controversial. In this study, we compared the long-term outcomes of patients undergoing aortic valve replacement with biological or mechanical aortic valve prostheses.
Methods: We evaluated late results among 5762 patients aged 45 to 74 years who underwent biological or mechanical aortic valve replacement with or without concomitant coronary artery bypass from 1989 to 2019 at 4 medical centers.
Article Synopsis
- Patients with adult congenital heart disease (ACHD) are increasingly facing heart failure, but there is limited research on their heart transplantation outcomes.
- A study analyzed 77 ACHD patients who underwent heart transplantation from 1990 to 2023, finding that univentricular (UniV) patients had higher rates of liver disease and required more multiorgan transplants compared to biventricular (BiV) patients.
- While UniV patients showed lower survival rates within the first year post-transplant, their long-term survival rates were comparable to BiV patients after one year, highlighting complex health challenges in this demographic.
Background: Septal myectomy improves symptoms in the majority of patients with obstructive hypertrophic cardiomyopathy (HCM), but there are limited prospective data on functional outcomes after operation.
Objectives: The authors investigated quality of life measures and prevalence of sexual dysfunction before and after septal myectomy for obstructive HCM.
Methods: Between January 2018 and October 2019, 436 patients underwent transaortic septal myectomy at our clinic.
Article Synopsis
- * Analysis of 50,625 operations showed that higher prior surgery counts (3 or more) significantly increased the risks: operative mortality rates rose from 0.6% for no prior surgeries to 6.3% for six or more.
- * The findings indicate that having three or more prior cardiopulmonary bypass operations is a strong independent risk factor for worse surgical outcomes, suggesting that further studies should focus on improving patient management and outcomes.