Publications by authors named "Elbert Williams"

Article Synopsis
  • Intraoperative implantation of leadless cardiac pacemakers (LCPs) during valve surgery is a new approach intended for patients at high risk of postoperative heart conduction issues.
  • A study assessing the long-term safety and effectiveness of this method evaluated 100 patients, all of whom underwent successful LCP implantation without any device-related complications during an average follow-up of about 10.6 months.
  • Results showed that 95% of patients had acceptable pacing thresholds at the 12-month follow-up, indicating that this technique is a safe alternative to traditional pacing methods.
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The Ross procedure is an excellent operation to treat children and adults with aortic valve disease. Compared to prosthetic aortic valve replacement, it provides important clinical benefits in terms of survival, hemodynamics, freedom from valve-related complications, and durability, especially in women of childbearing age. However, the Ross procedure is a longer and technically more challenging operation.

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Total artificial heart is associated with increased incidence of thromboembolism, which can prove to be fatal. The presence of four metallic tilting discs increases the chances of thrombus formation and sudden obstruction of the valve in a closed position resulting in severe hemodynamic collapse. Such a condition is conventionally treated by a surgical approach for device change; however, this procedure is extremely high risk and associated with complications and poor outcomes.

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Background: There has recently been renewed interest in the Ross procedure in adults.

Objectives: The goal of this study was to compare long-term outcomes after the Ross procedure vs biological and mechanical aortic valve replacement (AVR) in adults (aged 18-50 years) undergoing aortic valve surgery.

Methods: Mandatory California and New York databases were queried between 1997 and 2014.

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The unique case of a child with idiopathic fibrosing mediastinitis mimicking neoplasm is presented. A 5-year-old boy presented with pneumonia and was found to have a complex, heterogeneous, and calcified mediastinal mass along the left hilum. Percutaneous and surgical biopsies, while suggesting a potential epithelial malignancy, were nonconclusive.

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Background: Potential for difficult reoperations has been a concern for patients undergoing a Ross procedure. Data regarding the outcomes of such reoperations is extremely limited. We examined our experience to define the current scope and risk of these operations.

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In the past decade, the treatment of aortic regurgitation has evolved from a strategy focused mainly on valve replacement to one of valve repair (AVr). Nevertheless, AVr has yet to gain broad acceptance within the surgical community despite excellent reported results in selected centers. In fact, AVr failure due to recurrence of regurgitation remains a challenge.

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Background And Aim Of The Study: Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR.

Methods And Results: In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database.

Conclusions: In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement.

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Patients with indications for emergent cardiac surgery procedures who have previously received a P2Y12 inhibitor loading dose are at extremely high risk for bleeding. We present a successful example of lateral thinking in solving a controversial clinical scenario.

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A left anterior descending artery (LAD) arising from the right coronary artery (RCA) or right sinus of Valsalva is an exceedingly rare anomalous variant occurring in 0.03% of the population. We here present the case of an 81-year-old male with severe triple vessel coronary artery disease who was found to have an aberrant LAD arising from the proximal RCA, and was successfully treated with off-pump, total arterial, and complete surgical revascularization.

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Off-pump, total arterial coronary artery bypass grafting (CABG) is a technically demanding myocardial revascularization strategy that combines the long-term benefits of multi-arterial CABG with a no-touch aortic technique. Dedicated training and mentoring are essential in order to learn how to successfully perform this challenging surgical procedure.  In this video-tutorial, we present  a complete step-by-step approach to safely reproduce this procedure.

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Background: The management of severe mitral annular calcification (MAC) with a conservative approach minimizes the risk of atrioventricular groove (AVG) disrupture. However, patients with a history of rheumatic valve disease may present with complex and mixed annular lesions requiring extensive debridement. Our technique for reconstructing the mitral annular plane after mechanical decalcification is presented.

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Although the median sternotomy has been the traditional approach for congenital heart surgery, young patients and their families often find the midline scar to be cosmetically unappealing. At our center, a right transverse axillary incision has become the standard approach for many congenital cardiac lesions because of its safety, versatility, and unsurpassed aesthetic result. We present our experience with the axillary approach for a diverse array of congenital defects.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare clinical entity that occurs in a small subset of acute pulmonary embolism (PE) cases and is surgically cured by pulmonary endarterectomy. We report a case of a 44-year-old female with a complex history of CTEPH treated by thromboendarterectomy who presented with a subdural hematoma while on warfarin. The patient eventually recovered by a multidisciplinary approach, use of inferior vena caval filter, and effective anticoagulation management.

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Objective: Impella 2.5 has been shown to reduce major adverse events for patients undergoing elective high-risk percutaneous coronary intervention. We performed a single-center retrospective study to compare the costs and resource use of Impella 2.

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Although myxomas are the most commonly seen primary cardiac tumors, encompassing 30% to 50% of all primary tumors of the heart, they remain a rare finding with an annual reported incidence of 0.5 per million. The presenting symptoms of an atrial myxoma are widely varied as are the clinical consequences.

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