Surgical Procedures, Operative Commons^™

All-Inside Arthroscopic Technique For Repairing Radial Meniscus Tears At The Anterior Horn-Body Junction, Brandon Omari Boyd, Robert M. Walker, Harrison A. Volaski, Ferdinand J. Chan

Department of Medicine Faculty Publications

Radial meniscus tears are a common tear pattern that, if left untreated, can ultimately lead to accelerated degenerative changes and disability. There is well-established evidence that supports meniscal preservation in patients with radial meniscus tears. Various surgical techniques are used to repair radial tears, including inside-out, outside-in, and all-inside methods. Self-retrieving all-inside devices are a safe option when repairing radial tears. However, radial tears at the junction of the anterior horn and body present a unique surgical challenge, as surgeons may have difficulty maneuvering the jaws of the self-retrieving suture device around the anterior limb of the meniscal tear. We …

Redo Tavr With Asymmetric Coronary Risk: Interpreting Borderline Ct Findings, Connor J. Mckechnie, Nicolas J. Valle, Omar A. Saleh, Matthew R. Summers, Deepak R. Talreja

Department of Medicine Faculty Publications

Image(s)

Computed tomography (CT) and computational modeling (DASI) in redo transcatheter aortic valve replacement (TAVR) planning.

Case Summary

A 77-year-old woman presented with severe symptomatic aortic stenosis due to degeneration of a prior transcatheter valve. CT demonstrated leaflet calcification with borderline left-sided valve-to-coronary distance (3.27 mm). Geometric assessment suggested low right coronary obstruction risk, but higher left main risk. Computational modeling demonstrated adequate leaflet-coronary clearance (distance from displaced leaflet cusp to coronary ostium normalized to coronary diameter >0.7). Redo TAVR with a 26-mm Evolut FX was performed without leaflet modification and no coronary obstruction.

Take-Home Message

Borderline CT findings in …

Novel Percutaneous Repair Of Femoral Pseudoaneurysms Using Perclose Proglide™: A Case Series, Ryan Mancoll, Emily Burnett, Nicholas Bandy, Benjamin Samberg, Thomas Cook, Jacob Hoffman, Christopher Murter, Matthew Rossi, David Dexter, Hosam El Sayed, Animesh Rathore Md

Cardiovascular Research Symposium

BACKGROUND - This case series details the novel use of the Perclose ProGlide closure device to successfully repair three separate cases of iatrogenic femoral pseudoaneurysms (PSAs) without attempting other modalities first. Conventional treatment methods of ultrasound-guided compression, duplex-directed thrombin injection (DDTI), or open surgical repair were contraindicated in these patients due to unique anatomy or advanced comorbidities.

METHODS – Details were gathered via a retrospective chart review.

RESULTS - In the first case, a 73-year-old female had an access site PSA off the superficial femoral artery (SFA) with concomitant arteriovenous fistula (AVF) and advanced cardiac disease. The ProGlide device was …

Cardiopulmonary Bypass Facilitates Emergent Tavr And Bifurcation Pci In A Highly Comorbid 72-Year-Old Female With Acute Valvular Shock, Omar Sale Bs, Nicholas Valle Do, Matthew Rossi Md, Joshua Cohen Md, Paul Lavigne Md, Matthew Summers Md

Cardiovascular Research Symposium

Title:

Cardiopulmonary Bypass Facilitates Emergent TAVR and Bifurcation PCI in a Highly Comorbid 72-year-old Female with Acute Valvular Shock

Introduction:

Transcatheter aortic valve replacement (TAVR) has emerged as a critical minimally invasive option for patients with severe AS who present in valvular shock, particularly those at prohibitive surgical risk. Multicenter registry data demonstrate that emergent TAVR in this population is associated with promising procedural success, significant improvements in functional status, and lower short- and long-term mortality compared to medical management or balloon aortic valvuloplasty, with outcomes approaching those of surgical aortic valve replacement in selected patients [1] [2]. We present …

Acute Valve Syndrome And 1-Year All-Cause Mortality Post-Avr: A Retrospective Cohort Study, Omar Sale Bs, Nicholas Valle Do, Israa Saleh, Omar Jafar Md, Matthew Summers Md

Cardiovascular Research Symposium

Background: Acute Valve Syndrome (AVS) identifies a high-risk cohort of aortic stenosis (AS) patients with poor outcomes following aortic valve replacement (AVR), but the spectrum of risk within this group has yet to be fully explored. We sought to evaluate whether admission markers facilitated risk stratification of 1-year mortality in an AVS cohort.

Methods: In a retrospective cohort study (MIMIC-IV v3.1), we identified 2,380 adults who underwent AVR between 2008–2019. Patients were classified as AVS or progressive valvular disease (PVD). AVS was defined by criteria of acute decompensation, including advanced heart failure symptoms, cardiogenic shock, or significant hyperlactatemia. The AVS …

Ai-Guided Simulation And Single-Cusp Cleve To Enable High-Risk Valve-In-Valve Tavr, Joshua Dolsen Md, Omar Sale Bs, Nicholas Valle Do, Matthew Summers Md

Cardiovascular Research Symposium

Title

AI-Guided Simulation and Single-Cusp CLEVE to Enable High-Risk Valve-in-Valve TAVR

Authors

Joshua Dolsen MD, Omar Saleh BSc, Nicholas Valle DO, Matthew Summers MD,

Introduction

Acute coronary obstruction is a rare but potentially fatal complication of transcatheter aortic valve replacement (TAVR), with a markedly increased risk in valve-in-valve (ViV) procedures due to anatomical constraints. The risk is further heightened in patients with complex anatomy, such as low coronary ostia or narrow sinuses of Valsalva. Despite advances in imaging and procedural techniques, pre-procedural risk stratification has remained largely static, relying primarily on pre-procedural imaging with Computed Tomography (CT). Recently, artificial intelligence …

Percutaneous Levoatrial Cardinal Vein Closure For Stroke Prevention, Chee Spencer, Amir Hasani, Alexander Ellis, David Adler

Department of Medicine Faculty Publications

We report 2 cases of cerebral embolism related to congenital levoatrial cardinal vein anomalies. Both patients had positive echocardiographic agitated saline studies but intact interatrial septum on transesophageal echocardiography. Levoatrial cardinal vein was diagnosed using computed tomography angiography. A novel technique for percutaneous levoatrial cardinal vein closure using vascular plug devices was successful in both patients.

Surgical Management Of Gastroenteropancreatic Neuroendocrine Tumors, Lisa M. Kenney, Marybeth Hughes

Department Surgery Faculty Publications

Background/Objectives: Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from enterochromaffin cells that can arise from the gastrointestinal (GI) tract and pancreas. Surgical management is the cornerstone of treatment, with the optimal approach tailored by tumor grade, size, location, and presence of metastasis. This review discusses the current strategies for the surgical management of NETs of the gastroenteropancreatic tract. Methods: A review of the available literature was conducted to evaluate surgical approaches to NETs. Consensus guidelines were incorporated to synthesize evidence-based recommendations. Results: For gastric NETs, surgical approach depends on Rindi Classification, WHO grade, and tumor size, with endoscopic approaches favored …

Long-Term Safety And Effectiveness Of The Treo Stent Graft For The Endovascular Treatment Of Infrarenal Abdominal Aortic Aneurysms, Matthew J. Eagleton, Michael C. Stoner, John Henretta, Maciej Dryjski, Jean M. Panneton, Apostolos Tassiopoulos, Manish Mehta, Benjamin Pearce, Mel J. Sharafuddin, Treo Investigators

Department Surgery Faculty Publications

Objective

Report on the long-term safety and effectiveness of the TREO stent graft in endovascular repair of AAA from a US investigational device clinical study.

Methods

Data from a multicenter, nonrandomized, prospective, US investigational device exemption pivotal study (NCT02009644) were used. From November 2013 to February 2016, 150 patients were enrolled at 29 US centers. Safety endpoints were defined as major adverse events (i.e., all-cause mortality, myocardial infarction, stroke, renal failure requiring renal replacement therapy, respiratory failure, paraplegia, bowel ischemia, and procedural blood loss of 1,000cc or greater). Effectiveness endpoints were defined as no aneurysm rupture, absence of sac increase …

Upper Airway Soot And Facial Burns Do Not Necessitate Intubation, Jessica Burgess, John Dubensky

Department Surgery Faculty Publications

Introduction

Identifying which patients are at risk for respiratory decompensation, whether from airway compromise or inhalation injury, is an important component of initial burn resuscitation. Findings that traditionally suggest the need for intubation include cutaneous burns to the face and neck, soot seen in the upper airway, and carbonaceous sputum. However, evidence suggests that a significant number of pre-burn center intubations are ultimately unnecessary. The purpose of this investigation was to determine if head and neck burns or sputum seen in the upper airways were correlated with the need for intubation.

Methods

This was a retrospective review of adults admitted …

Is It Getting Better? An Evaluation Of Two Successive Generations Of Chatgpt In Answering Specialized Vascular Surgery Questions, Dongjin Suh, Quang Le, Leana Dogbe, Kedar Lavingia, Michael Amendola

Department Surgery Faculty Publications

Purpose: Large language models (LLMs) can generate clinically relevant text; however, their performance in highly specialized medical domains remains uncertain. This study evaluated ChatGPT-3.5 and ChatGPT-4 (OpenAI) using vascular surgery board–style questions from the Vascular Education and Self-Assessment Program, version 4 (VESAP4) and compared the two public model versions (June and November 2023).

Materials and Methods: All non-image VESAP4 questions (n=384) were presented independently three times to each model version (ChatGPT-3.5 June/November; ChatGPT-4, June/November). Outcomes included accuracy (proportion correct), consistency (same option letter across all three attempts and “consistently correct”), explanation length (word count), and modes of failure classified for …

A Customized Large Single-Piece Bifrontal Implant For Post-Craniectomy Defect Reconstruction: A Case Study, Omid Ghaderzadeh, Ehsan Amirbeyk, Seyed Roholah Ghodsi, Zahra Namazi, Lobat Tayebi

Electrical & Computer Engineering Faculty Publications

Background: Large bifrontal defects pose unique reconstruction challenges due to their complex curvature and mechanical requirements. This case demonstrated how computer-aided design/manufacturing (CAD/CAM) enabled precise single-piece polymethyl methacrylate (PMMA) implant fabrication, thereby overcoming traditional limitations. Case presentation: A 25-year-old male who had undergone bifrontal decompressive craniectomy suffered a severe traumatic brain injury. The autologous bone flap had been temporarily stored in a subcutaneous fat area of the abdomen for 3 months to preserve its viability. A secondary cranioplasty was then performed using titanium miniplates and self-tapping screws for final fixation. After 2 years, the patient developed empyema and a brain …

St-Elevation In Avr With Diffuse St-Segment Depression: Need For Urgent Catheterization?, Bruce M. Lo, Megyn K. Christensen, Katherine E. Schaffer, Theodore J. Tzavaras

Department of Emergency Medicine Faculty Publications

Case Presentation: A 33 year old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-depression. An emergent catheterization was performed which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications.

Discussion: Previous guidelines suggested that ST-elevation with diffuse ST-depression should be treated as a STEMI-equivalent involving the left-main or proximal left anterior descending coronary artery. However recent data suggests that the majority of these cases may not involve …

Robotically Steered Needles: A Survey Of Neurosurgical Applications And Technical Innovations, Michel A. Audette, Stéphane P.A. Bordas, Jason E. Blatt

Computational Modeling & Simulation Engineering Faculty Publications

This paper surveys both the clinical applications and main technical innovations related to steered needles, with an emphasis on neurosurgery. Technical innovations generally center on curvilinear robots that can adopt a complex path that circumvents critical structures and eloquent brain tissue. These advances include several needle-steering approaches, which consist of tip-based, lengthwise, base motion-driven, and tissue-centered steering strategies. This paper also describes foundational mathematical models for steering, where potential fields, nonholonomic bicycle-like models, spring models, and stochastic approaches are cited. In addition, practical path planning systems are also addressed, where we cite uncertainty modeling in path planning, intraoperative soft tissue …

An Integrated Computer-Aided Robotic System For Dental Implantation, Xiaoyan Sun, Yongki Yoon, Jiang Li, Frederic D. Mckenzie

Electrical & Computer Engineering Faculty Publications

This paper describes an integrated system for dental implantation including both preoperative planning utilizing computer-aided technology and automatic robot operation during the intra-operative stage. A novel two-step registration procedure was applied for transforming the preoperative plan to the operation of the robot, with the help of a Coordinate Measurement Machine (CMM). Experiments with a patient-specific phantom were carried out to evaluate the registration error for both position and orientation. After adopting several improvements, registration accuracy of the system was significantly improved. Sub-millimeter accuracy with the Target Registration Errors (TREs) of 0.38±0.16 mm (N=5) was achieved. The target orientation errors after …