EuroSCORE predicts short- and mid-term mortality in combined aortic valve replacement and coronary artery bypass patients.

Background And Aim Of The Study: European system for cardiac operative risk evaluation (EuroSCORE) has been studied for its effectiveness in predicting operative mortality, and more recently, long-term mortality in a wide variety of cardiac surgical procedures. Combined coronary artery bypass and aortic valve replacement (AVR-CABG) carries increased perioperative risk, and tends to have higher-risk patients. Performance of the EuroSCORE system in patients undergoing concomitant AVR-CABG has not been well established.

Alpha II-spectrin breakdown products serve as novel markers of brain injury severity in a canine model of hypothermic circulatory arrest.

Background: The development of specific biomarkers to aid in the diagnosis and prognosis of neuronal injury is of paramount importance in cardiac surgery. Alpha II-spectrin is a structural protein abundant in neurons of the central nervous system and cleaved into signature fragments by proteases involved in necrotic and apoptotic cell death. We measured cerebrospinal fluid alpha II-spectrin breakdown products (alphaII-SBDPs) in a canine model of hypothermic circulatory arrest (HCA) and cardiopulmonary bypass.

Idiopathic pulmonary artery aneurysm treated with surgical correction and concomitant coronary artery bypass grafting.

Idiopathic pulmonary artery aneurysm is a rare clinical entity, and therefore the natural course and clinical management are not well established. We present the case of an elderly woman with a symptomatic idiopathic pulmonary artery aneurysm who underwent surgical repair along with simultaneous coronary artery bypass grafting. With long-term follow-up presented in this report, we describe the safety and durability of surgical repair.

Inspiring medical students to pursue surgical careers: outcomes from our cardiothoracic surgery research program.

Background: The past several years have witnessed a dramatic decline in the number of general surgery residents pursuing cardiothoracic surgery residency training. We believe that attracting individuals to pursue surgical careers should begin during the formative years of medical education. We implemented a program to introduce first-year medical students to cardiothoracic surgery and laboratory research.

Aortic root replacement in 372 Marfan patients: evolution of operative repair over 30 years.

Background: We reviewed the evolution of practice and late results of aortic root replacement (ARR) in Marfan syndrome patients at our institution.

Methods: A retrospective clinical review of Marfan patients undergoing ARR at our institution was performed. Follow-up data were obtained from hospital and office records and from telephone contact with patients or their physicians.

Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the United Network for Organ Sharing Database.

Background: Generally accepted donor criteria for heart transplantation limit allografts from donors within approximately 20% to 30% of the recipient's weight. We analyzed the impact of donor-to-recipient weight ratio on survival after heart transplantation.

Methods And Results: Adult heart transplant recipients reported to the United Network for Organ Sharing from 1999 to 2007 were divided into 3 groups based on donor-to-recipient weight ratio: <0.

Surgical ventricular restoration versus cardiac transplantation: a comparison of cost, outcomes, and survival.

Background: Cardiac transplantation is the accepted standard treatment for end-stage heart disease but is donor limited. Surgical ventricular remodeling is an established treatment for patients with ischemic cardiomyopathy. We sought to compare charges, outcomes, and survival in patients undergoing surgical ventricular restoration (SVR) versus cardiac transplantation (CTx).

Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison.

Background: Coronary artery bypass grafting (CABG) is an effective treatment for ischemic cardiomyopathy. However, patients with ventricular enlargement are known to have inferior outcomes. We assessed whether surgical ventricular restoration (SVR) with CABG (SVR + CABG) leads to improved outcomes versus CABG alone for patients with ischemic cardiomyopathy and ventricular enlargement.

The impact of surgical ventricular restoration on mitral valve regurgitation.

Background: Surgical management of functional mitral regurgitation (MR) in ischemic cardiomyopathy is controversial. Surgical ventricular restoration (SVR) decreases left ventricular volume and may improve MR severity. We assessed the impact of SVR on the degree of MR.

Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures.

Background: We compared results of the Bentall procedure with valve-sparing aortic root replacement (VSRR) for aortic root aneurysm in Marfan syndrome.

Methods: Marfan syndrome patients who had the Bentall procedure or VSRR at our institution between April 1997 and September 2006 were identified. Follow-up information was obtained from hospital charts and contact with patients or their physicians.

Pretransplant panel reactive antibodies in human lung transplantation: an analysis of over 10,000 patients.

Background: The role of panel reactive antibody (PRA) in lung transplant recipients has not been clearly defined in a large population. We sought to determine how panel reactive antibody level affects survival in lung transplant recipients.

Methods: The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research files from 1987 through 2005 were analyzed.

Optimal timing of coronary artery bypass after acute myocardial infarction: a review of California discharge data.

Objective: The optimal timing for coronary artery bypass grafting after acute myocardial infarction is not well established. The California Discharge Database facilitates the study of this issue by providing data from a large patient cohort free of institutional bias. We examine the timing of coronary artery bypass grafting after acute myocardial infarction on short-term outcomes.

Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database.

Background: Patients 60 years and older have traditionally not been considered candidates for orthotopic heart transplantation (OHT). Recent studies have shown equivalent survival between older and younger patients, leading many to question this traditional ethos. As these studies may lack significant power to draw meaningful conclusions, the United Network for Organ Sharing (UNOS) database provides a unique opportunity to examine the effects of age on OHT.

Outcomes in bicaval versus biatrial techniques in heart transplantation: an analysis of the UNOS database.

Background: Despite 40 years of heart transplantation, the optimal atrial anastomotic technique remains unclear. The United Network for Organ Sharing (UNOS) database provides a unique and novel opportunity to address this question by examining survival in a large cohort of patients undergoing orthotopic heart transplantation (OHT). We hypothesized that, when examining the issue on a large scale, no difference in survival would exist between techniques.

Impact of septal myocardial infarction on outcomes after surgical ventricular restoration.

Background: Surgical ventricular restoration (SVR) is classically performed in heart failure patients with anteroseptal infarction. It is unknown how the extent of septal myocardial infarction (SMI) affects prognosis. We reviewed our experience to evaluate the impact of the extent of SMI on outcomes after SVR.

Two thousand Blalock-Taussig shunts: a six-decade experience.

Background: The Blalock-Taussig shunt (BTS) remains valuable for palliation of congenital heart disease, but its role has evolved. We reviewed our total institutional experience with BTS to examine changes in its use and outcomes.

Methods: A retrospective review was performed of all patients undergoing BTS at our institution from November 1944 to May 2006.

Influence of pretransplant panel-reactive antibody on outcomes in 8,160 heart transplant recipients in recent era.

Background: Panel-reactive antibody (PRA) screening to detect HLA antibodies is an important part of evaluation for potential heart transplant recipients. We sought to determine how different levels of PRA affect outcomes in heart transplantation.

Methods: A retrospective cohort study of using data reported to the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) registry from January 1, 2000, to December 31, 2004, was performed.

Outcomes following surgical ventricular restoration for patients with clinically advanced congestive heart failure (New York Heart Association Class IV).

Background: It has been well documented that survival in patients with advanced congestive heart failure (CHF) receiving medical therapy is worse with advancing stages of disease (New York Heart Association [NYHA] IV versus NYHA III). However, such comparisons are rare in the surgical treatments for CHF. Surgical ventricular restoration (SVR) is an accepted therapy for patients with ischemic cardiomyopathy after anterior wall myocardial infarction.

Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass.

Objective: Optimal management of patients with combined coronary and carotid artery disease remains controversial. This study analyzed the outcomes between simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. isolated CABG.

Improved outcome after repair of descending and thoracoabdominal aortic aneurysms using modern adjuncts.

Objectives: To evaluate current strategies to decrease spinal cord and organ dysfunction in patients undergoing repair of descending and thoracoabdominal aneurysms.

Methods: We reviewed 94 consecutive cases of descending and thoracoabdominal aortic aneurysm repairs to determine the impact of modern adjuncts on postoperative neurologic deficit and mortality. The adjuncts used in these patients included perioperative cerebrospinal fluid drainage, distal aortic perfusion, reattachment of critical intercostal vessels, permissive hypothermia and hypothermic circulatory arrest with antegrade cerebral perfusion.

Impact of lateral wall myocardial infarction on outcomes after surgical ventricular restoration.

Background: Surgical ventricular restoration (SVR) attempts to reverse negative ventricular remodeling after anterior myocardial infarction (MI). However, the impact of lateral wall MI (LMI) on SVR outcomes is unknown.

Methods: We retrospectively reviewed SVR patients between January 2002 and December 2005.

Outcomes following surgical ventricular restoration in elderly patients with congestive heart failure.

Despite the well described benefits of surgical ventricular restoration (SVR) for patients with ischemic cardiomyopathy, the effects of advanced age on outcomes following this procedure have not been well documented. The authors compared outcomes in 69 consecutive patients 65 years and older (n=27) and younger than 65 years (n=42) to determine the utility of SVR in an elderly population with end-stage heart failure. Patients 65 years and older demonstrated significant improvements in ejection fraction (P=.

Aortic valve replacement and concomitant coronary artery bypass: assessing the impact of multiple grafts.

Background: The impact of multivessel coronary artery disease and multivessel coronary artery bypass grafting on outcomes after combined aortic valve replacement and coronary artery bypass grafting (AVR-CABG) has not been sufficiently evaluated.

Methods: We retrospectively reviewed all patients who underwent AVR-CABG at our institution between January 2000 and December 2004. Patients with any previous or concomitant procedures were excluded.

Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database.

Objective: Lung transplantation has been increasingly applied to patients over the age of 60 years. Importantly, the procedure of choice, single versus bilateral lung transplantation, remains unclear. Therefore, the purpose of this study was to examine short- and midterm outcomes in this age group with particular attention to procedure type.

Early surgical experience with Loeys-Dietz: a new syndrome of aggressive thoracic aortic aneurysm disease.

Background: Loeys-Dietz syndrome (LDS) is a recently described genetic aortic aneurysm syndrome resulting from mutations in receptors for the cytokine transforming growth factor-beta. Phenotypic features include a bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity, but risk of thoracic aortic rupture and dissection is the principle focus of management and exceeds that of most known connective tissue disorders. Our surgical experience with LDS was reviewed to assess outcomes and develop guidelines for management of this aggressive disease.