Publications by authors named "Penny L Houghtaling"
Article Synopsis
- The study aimed to assess if using multiple arterial grafts in redo coronary artery bypass grafting (CABG) offers any advantages over using a single arterial graft.
- Over a 40-year period, researchers examined data from 6,559 patients who underwent isolated redo CABG, matching those who received multiarterial grafts with those who received single arterial grafts to evaluate in-hospital complications and long-term survival.
- Results indicated that multiarterial grafting was linked to lower in-hospital mortality and better long-term survival rates, especially in males with two internal thoracic artery grafts.
Objective: To determine the durability of mitral valve repair (MVr) with complete ring or flexible band annuloplasty in patients with atrial functional mitral regurgitation (AFMR) due to atrial fibrillation (AF) and identify risk factors associated with postoperative recurrence of mitral regurgitation.
Methods: Between January 1, 2000, and January 1, 2023, 194 adults with a history of AF underwent MVr with annuloplasty alone for moderate/severe AFMR. Exclusion criteria were prior cardiac surgery, additional repair techniques, ejection fraction <45%, ischemic heart disease, aortic valve disease, mitral annular calcification, and concomitant procedures other than surgical ablation or tricuspid repair/replacement.
Article Synopsis
- Persons who inject drugs and undergo surgery for infective endocarditis face serious challenges, including high rates of loss to follow-up, relapse, and mortality despite low in-hospital death rates.
- The study analyzed 227 patients from 2010 to 2020, revealing that heroin was the most commonly injected drug and highlighting significant psychosocial issues such as homelessness and mental health disorders.
- Findings indicated a need for improved postoperative addiction management strategies, as a significant portion of patients experienced relapse and loss to follow-up, demonstrating the urgent requirement for effective interventions.
Article Synopsis
- * A study conducted from 2008 to 2022 involved 2,324 patients undergoing 2,352 multivalve reoperations, revealing that complexity and urgency of the surgery increase mortality risk.
- * Findings suggest that elective, isolated surgeries have a low mortality rate and that understanding surgical complexity and patient health factors can guide better decision-making in surgical settings.
Article Synopsis
- The study aimed to examine the outcomes and risks associated with aortic root allograft reoperations, comparing data from before and after a previous study in 2006.
- Researchers analyzed data from 602 patients over 33 years, focusing on reoperation causes, techniques used, and their respective morbidity and mortality rates.
- The findings indicate that reoperations can be performed with low risks, with radical explant yielding outcomes similar to aortic valve replacement, suggesting surgeons should not hesitate to use allografts due to the risks of reoperation.
Reoperation after early and late failure of mitral valve repair for degenerative disease.
J Thorac Cardiovasc Surg
April 2024
Objectives: To determine mechanisms of early and late failure after mitral valve repair for degenerative disease, identify factors associated with re-repair, and evaluate durability of re-repair.
Methods: From January 2008 to July 2020, 330 reoperations were performed for recurrent mitral valve dysfunction after initial valve repair for degenerative disease. Mechanisms of repair failure were determined by review of preoperative imaging and operative reports.
Article Synopsis
- - The study analyzed the long-term patency rates of right internal thoracic artery (RITA) grafts used in coronary artery bypass grafting from 1972 to 2016, focusing on different inflow configurations and their effects on graft occlusion rates.
- - Results showed that RITA patency was generally high over time, with rates of 90% at 1 year, and about 86-87% at 5 to 15 years, and there were no significant differences in occlusion rates among various inflow configurations when adjusting for target coronary locations.
- - The findings suggest that instead of prioritizing the inflow configuration, surgeons should focus on optimizing RITA's reach to critical coronary arteries, particularly
Background: Reoperative cardiac surgery in patients with patent bilateral internal thoracic artery (ITA) grafts is technically challenging.
Methods: From 2008 to 2017, of 7640 patients undergoing reoperative cardiac surgery, 116 (1.5%) had patent bilateral ITA grafts, including 28 with a right ITA crossing the midline.
Article Synopsis
- The study investigates the risk of infection associated with cryopreserved allograft aortic root replacements, analyzing data from 2042 patients over a 30-year period.
- Findings revealed that allograft infections occur in about 5.6% of cases for nonendocarditis patients and 14% for those with endocarditis, with specific risk factors identified for each group.
- The overall low infection rates support the ongoing use of allografts, especially for treating invasive endocarditis conditions of the aortic root.
Modern practice and outcomes of reoperative cardiac surgery.
J Thorac Cardiovasc Surg
December 2022
Article Synopsis
- This study evaluates the outcomes of reoperative cardiac surgery with a focus on the timing of cardiopulmonary bypass (CPB) before re-sternotomy in patients at Cleveland Clinic between 2008 and 2017.
- A total of 6,627 patients were analyzed, with procedures mostly involving aortic valve replacement and coronary artery bypass grafting; overall operative mortality was low at 3.5%.
- The analysis found no significant differences in mortality or major complications between early and late CPB groups, indicating that both strategies are effective in a well-coordinated and experienced surgical environment.
Background: Cardiac surgery accounts for 10-15% of blood transfusions in the US, despite benefits and calls of limiting its use. We sought to evaluate the impact of a restrictive transfusion protocol on blood use and clinical outcomes in patients undergoing isolated primary coronary artery bypass grafting (CABG).
Methods: Blood conservation measures, instituted in 2012, include preoperative optimization, intraoperative anesthesia, and pump fluid restriction with retrograde autologous priming and vacuum-assisted drainage, use of aminocaproic acid and cell saver, intra- and postoperative permissive anemia, and administration of iron and low-dose vasopressors if needed.
Article Synopsis
- The study evaluates the performance and longevity of aortic allografts used for replacements, particularly in cases of infective endocarditis, over a 30-year period involving over 2,000 patients.
- Allografts showed satisfactory hemodynamic performance with a low percentage of severe aortic regurgitation at discharge, but increased rates of regurgitation and structural failures were observed over time, particularly influenced by recipient age and donor characteristics.
- The findings suggest that while there are concerns about allograft durability, factors contributing to structural failure can be managed, and allografts remain a viable option for aortic root replacements.
Article Synopsis
- The study investigates the success of heart bypass grafts in patients on dialysis, focusing on the internal thoracic artery (ITA) and saphenous vein grafts (SVGs) after coronary artery bypass grafting (CABG).
- Data collected from 500 patients over 21 years showed that while ITA grafts had a low occlusion rate, SVGs had significantly lower patency rates than expected, with only 52% and 37% remaining open at 1 and 2 years, respectively.
- The findings highlight the need for better graft selection and strategies to improve graft success in this high-risk patient group, due to their poor overall prognosis.
Article Synopsis
- This study examines how the dominance of the left anterior descending (LAD) artery and other coronary vessel targets affect survival rates after bilateral internal thoracic artery (BITA) grafting in heart patients.
- Out of 6,127 BITA procedures from 1972 to 2011, the presence of a dominant LAD was linked to patients having less important secondary targets, with patients receiving grafts to multiple important targets showing better long-term survival outcomes.
- Overall, bypassing multiple significant coronary arteries was associated with improved survival, while grafting to less important arteries in patients with a nondominant LAD increased mortality risk, highlighting the importance of selecting significant targets for grafting. *
Article Synopsis
- - The study analyzed telemetry monitoring data from 72,199 hospital patients over 13 months, finding that 3.7% activated emergency response teams (ERT), with nearly half of those events being cardiac-related.
- - Patients with deep venous thrombosis or pulmonary embolism had the highest ERT activation rates, with a significant portion of these events being cardiac-related, and patients awaiting coronary revascularization also showed notable cardiac issues.
- - The findings suggest that standardized telemetry monitoring can help identify high-risk patients, allowing for better prioritization of resources during times of limited availability, especially for cardiac and arrhythmia-specific events.
Article Synopsis
- The study evaluated the accuracy of four wearable heart rate monitors in patients with cardiovascular disease during cardiac rehabilitation sessions involving exercise.
- Results showed that the Polar H7 chest strap monitor was the most accurate compared to standard ECG, while other wrist-worn devices like the Apple Watch and Fitbit Blaze showed varying levels of accuracy.
- The findings suggest that for precise heart rate measurement in cardiac patients, traditional electrode-based monitors are recommended over optical wrist monitors, particularly in home rehabilitation settings.
Article Synopsis
- This study evaluates long-term outcomes of two surgical methods for reconstructing the intervalvular fibrosa (IVF) in patients with severe double-valve infective endocarditis (IE) from 1988 to 2017.
- Among 138 patients, high rates of complications were noted, with 82% requiring reoperations and an overall survival rate of 67% at 1 year, declining to 37% at 10 years.
- The hemi-Commando procedure, which involves mitral valve repair, showed better early outcomes compared to the full Commando procedure, emphasizing its effectiveness in certain cases of IE.
Article Synopsis
- Abnormal red cell distribution width (RDW) is linked to poorer outcomes after cardiac surgery, indicating it’s a key predictor of complications and longer hospital stays.
- Data from over 16,000 patients were analyzed, revealing that higher RDW levels correspond to a greater need for blood transfusions, while mean corpuscular volume (MCV) also plays a role but is less significant compared to RDW.
- Both RDW and MCV should be factored in when assessing the risks associated with cardiac surgery, with RDW being the more critical indicator for postoperative outcomes.
Background: Damage to the cardiac conduction system requiring permanent pacemaker implantation is a complication of aortic valve replacement (AVR) that may importantly affect quality of life. We investigated the prevalence of and preprocedure risk factors for new permanent pacemakers after surgical (SAVR) and transcatheter AVR (TAVR) at a single institution.
Methods: Preoperative variables and baseline electrocardiograms were reviewed for 5807 patients undergoing elective SAVR, with or without coronary artery bypass grafting, and 1292 undergoing TAVR, with or without percutaneous coronary intervention, from 2006 to 2017 at Cleveland Clinic.
Article Synopsis
- The study aimed to evaluate the safety and effectiveness of negative-pressure wound therapy (NPWT) compared to traditional methods for treating noninfected open chests following cardiac surgery.
- Researchers analyzed data from 452 patients over 15 years, with NPWT being used in 214 cases and traditional therapy in 238.
- Results indicated that NPWT resulted in fewer reexplorations for bleeding and improved early survival rates, suggesting it as a preferable method for post-surgical open-chest management.
Article Synopsis
- Right-sided infective endocarditis is on the rise, particularly due to factors like injection drug use and cardiac devices, leading to a study of surgical outcomes over 13 years for 134 adult patients.
- Most patients had tricuspid valve infections, with survival rates significantly influenced by their underlying health issues rather than the specific condition that predisposed them to the infection.
- Injection drug users had the best early survival, while those with chronic vascular access experienced the worst long-term outcomes; additionally, surgery outcomes varied with tricuspid valve replacement yielding poorer survival compared to repairs.
Article Synopsis
- * A study of 326 patients showed that at 15 years, the patency rates for ITA grafts were 99% for the proximal segment, 97% for sequential segments, and 90% for Y grafts, indicating generally good long-term effectiveness.
- * The findings suggest that while Y grafts have lower patency rates compared to sequential grafts, they still outperform traditional saphenous vein grafts, and using sequential or Y configurations doesn't negatively impact the inflow portion of the