Cardiology Commons^™

Safety And Long-Term Efficacy Of Thoracoscopic Epicardial Ablation In Patients With Paroxysmal Atrial Fibrillation: A Retrospective Study, John Johnkoski, Bryan Miles, Anna Sudbury, Mohammed Osman, Muhammad Bilal Munir, Sudarshan Balla, Mina M. Benjamin

Faculty & Staff Scholarship

Background: The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). Methods: This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF …

Surgical Correction Of Aortic Regurgitation Using A Haart 300™ Rigid Aortic Ring: A Novel Method To Standardize Aortic Valve Repair, Radoslaw Gocol, Marek Jasiński, Damian Hudziak, Jaroslaw Bis, Aleksandra Żak, Piotr Duraj, Magdalena Mizia, J. Scott Rankin, Marek A. Deja

Faculty & Staff Scholarship

No abstract provided.

The Patient Selection Criteria For Veno-Arterial Extracorporeal Mechanical Oxygenation, Sandeep Banga, Abhiram Challa, Avani R. Patel, Shantanu Singh, Vamsi K. Emani

Faculty & Staff Scholarship

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) plays a crucial role in the management of patients with refractory cardiac and pulmonary dysfunction by providing temporary mechanical hemodynamic and respiratory support. However, the paucity of guidelines on indications for administering it and the failure to timely initiate VA-ECMO often result in a high in-hospital mortality rate and poor six-month outcomes after VA-ECMO deployment. Due to ethical issues, randomized controlled studies with VA-ECMO have not been conducted so that no recommended evidence-based guidelines exist for VA-ECMO patientselection criteria. Therefore, the indication for administering the device depends solely on expert opinion after reviewing the literature. …

Cardiac Prostheses‐Related Hemolytic Anemia, Mohamad Alkhouli, Ali Farooq, Ronald S. Go, Sudarshan Balla, Chalak Berzingi

Faculty & Staff Scholarship

Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis-related hemolysis.

Trial Sequential Analysis Comparing Bleeding And Major Adverse Cardiovascular Events In Patients With Atrial Fibrillation And Acute Coronary Syndrome On Dual Versus Triple Therapy, Muhamad B. Munir, Khansa Osman, Maryam Saleem, Kinjan Patel, Sudarshan Balla

Faculty & Staff Scholarship

Objective To assess efficacy and safety of dual therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI) and evaluate the quality of evidence with respect to said outcomes based on contemporary randomized trials (RCTs). The efficacy outcome taken was major adverse cardiovascular events (MACE) while safety outcome was major bleeding events. Introduction Appropriate anti-thrombotic therapy is still controversial in patients with AF and concomitant ACS or PCI. We conducted a conventional meta-analysis pooling data from major RCTs to assess the efficacy and safety of DT …

Racial Disparities In The Utilization And Outcomes Of Structural Heart Disease Interventions In The United States, Mohamad Alkhouli, Fahad Alqahtani, David R. Holmes, Chalak Berzingi

Faculty & Staff Scholarship

Background-—Data on race- and ethnicity-based disparities in the utilization and outcomes of structural heart disease interventions in the United States are scarce. Methods and Results-—We used the National Inpatient Sample (2011-2016) to examine racial and ethnic differences in the utilization, in-hospital outcomes, and cost of structural heart disease interventions among patients ≥65 years of age. A total of 106 119 weighted hospitalizations for transcatheter aortic valve replacement, transcatheter mitral valve repair, and left atrial appendage occlusion were included. The utilization rates (defined as the number of procedures performed per 100 000 US people >65 years of age) were higher in …

Cardiovascular Risk Factor Control And Lifestyle Factors In Young To Middle-Aged Adults With Newly Diagnosed Obstructive Coronary Artery Disease, M. S. Garshick, G. D. Vaidean, A. Vani, J. A. Underberg, J. D. Newman, J. S. Berger, E. A. Fisher, E. Gianos

Journal Articles

No abstract provided.

First Series Of Minimally Invasive, Robot-Assisted Tracheobronchoplasty With Mesh For Severe Tracheobronchomalacia, R. Lazzaro, B. Patton, P. Lee, J. Karp, E. Mihelis, S. Vatsia, S. J. Scheinerman

Journal Articles

No abstract provided.

Single-Direction Thoracoscopic Lobectomy: A Step In The Right Direction, J. S. Young, P. C. Lee

Journal Articles

No abstract provided.

Predictors And Impact Of Right Heart Failure Severity Following Left Ventricular Assist Device Implantation, R. D. Baxter, K. M. Tecson, S. Still, J. D. G. Collier, J. Felius, S. M. Joseph, S. A. Hall, B. Lima

Journal Articles

No abstract provided.

Incidence Of Acute Kidney Injury In Patients With Chronic Renal Insufficiency: Transcatheter Versus Surgical Aortic Valve Replacement, M. Catalano, D. Lin, H. Cassiere, N. Kohn, B. Rutkin, G. Maurer, J. A. Berg, R. Esposito, A. Hartman, P. Yu, +1 Additional Author

Journal Articles

No abstract provided.

Robotic Sleeve Resections: New Territory But Not The Final Frontier, B. D. Patton

Journal Articles

No abstract provided.

Wide Complex Tachycardia In An Elderly Woman Due To Ebstein's Anomaly With Two Accessory Pathways, V. Radulescu, J. Donnelly, J. Willner, S. Beldner, A. Patel, S. G. Saba

Journal Articles

No abstract provided.

A Novel Diagnostic Approach To A Mass On A Device Lead, D. Chang, J. Gabriels, S. Laighold, A. K. Williamson, H. Ismail, L. M. Epstein

Journal Articles

No abstract provided.

Changes In Pulmonary Artery Pressure Before And After Left Ventricular Assist Device Implantation In Patients Utilizing Remote Haemodynamic Monitoring, A. Kilic, J. N. Katz, S. M. Joseph, M. A. Brisco-Bacik, N. Uriel, B. Lima, R. Agarwal, R. Bharmi, D. J. Farrar, S. Lee

Journal Articles

No abstract provided.

Current Aats Guidelines On Surgical Treatment Of Infective Endocarditis, G. B. Pettersson, S. T. Hussain

Journal Articles

© Annals of Cardiothoracic Surgery. The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, …

Necrotizing Infection Of The Aortic Arch: Reconstruction Utilizing Unusual Extra-Anatomic Bypass Grafts To Reroute Cerebral Blood Flow., J. M. Hemli, B. D. Patton, S. J. Scheinerman, D. R. Brinster

Journal Articles

Destructive infections of the aortic arch and great vessels are challenging to manage. We describe a novel technique for debranching the right cerebral and upper extremity arteries via composite extra-anatomic bypasses from the femoral artery, with subsequent homograft in-line reconstruction of the arch, in a patient with Staphylococcus sepsis and necrosis of the arch and great vessels.

Conduction Abnormalities After Transcatheter Aortic Valve Replacement, S. Kanjanauthai, K. Bhasin, L. Pirelli, C. A. Kliger

Journal Articles

© RADCLIFFE CARDIOLOGY 2019 Transcatheter aortic valve replacement (TAVR) has been established as a therapeutic option for patients with severe symptomatic aortic stenosis who are of intermediate or higher surgical risk. Several periprocedural complications are reduced with newer transcatheter heart valve generations; however, conduction abnormalities and the need for permanent pacemaker implantation have remained unchanged and are the most frequent TAVR complications. The close relationship of the atrioventricular node and left bundle branch to the subaortic region explains these potential conduction abnormalities. This article highlights conduction abnormalities after TAVR with a focus on basic conduction system anatomy in relation to …

Nonemergent Percutaneous Coronary Intervention On An Unprotected Left Main Coronary Artery Supported With Impella® Heart Pump In Patients Ineligible For Surgical Revascularization, P. M. Meraj, S. Dixon, J. Moses, K. Ibrahim, A. Schäfer, I. Akin, J. Hill, T. Schreiber, W. W. O'Neill

Journal Articles

© 2019 Perwaiz M. Meraj et al. Objectives. We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella® heart pump support. Background. ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. Methods. Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) …

Myocardial Fibrosis And Arrhythmogenesis In Elite Athletes, S. A. Ahmad, N. Khalid, E. Shlofmitz, L. Chhabra

Journal Articles

No abstract provided.

The Role Of Novel Oral Anticoagulants And Antiplatelet Therapy After Percutaneous Coronary Intervention: Individualizing Therapy To Optimize Outcomes, E. Shlofmitz, R. Shlofmitz, M. S. Lee

Journal Articles

No abstract provided.

Longitudinal Low Density Lipoprotein Cholesterol Goal Achievement And Cardiovascular Outcomes Among Adult Patients With Familial Hypercholesterolemia: The Cascade Fh Registry, P. B. Duell, S. S. Gidding, R. L. Andersen, T. Knickelbine, L. Anderson, E. Gianos, P. Shrader, I. Kindt, E. C. O'Brien, J. W. Knowles, +17 Additional Authors

Journal Articles

© 2019 [The Author/The Authors] Background and aims: There are limited data from the US on outcomes of patients in specialty care for familial hypercholesterolemia (FH). Methods: CASCADE FH Registry data were analyzed to assess longitudinal changes in medication usage, in low density lipoprotein cholesterol (LDL-C) levels, and the rate of major adverse cardiovascular events (MACE (myocardial infarction, coronary revascularization, stroke or transient ischemic attack) in adults with FH followed in US specialty clinics. Results: The cohort consisted of 1900 individuals (61% women, 87% Caucasian), with mean age of 56 ± 15 years, 37% prevalence of ASCVD at enrollment, mean …

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, L. Pennells, S. Kaptoge, A. Wood, M. Sweeting, X. Zhao, I. White, S. Burgess, P. Willeit, K. W. Davidson, E. Di Angelantonio, +90 Additional Authors

Journal Articles

© 2018 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. Aims There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Choosing Catheter Sheath Introducers In Infants-Information You Are Not Provided But Should Have!, Christopher Mathis, Ryan Romans, Abhay Divekar

Posters

Background: The advertised catheter sheath introducer (CSI) size, the internal diameter (ID), defines the maximum size of medical devices that can pass through it. However, the outer diameter (OD) determines the risk of vascular injury, varies considerably between manufacturers, and is not advertised. The highest risk of vascular injury is in infants less than one year of age and 3 - 6Fr CSIs are typically used.

Methods: The OD of 3, 3.3, 4, 5, and 6F CSIs (5 of each size) from different manufacturers were measured using a Mitutoyo Digital Micrometer. CSIs were measured with the dilator in place. Three …

Primary Cardiac Sarcoma: A Rare, Aggressive Malignancy With A High Propensity For Brain Metastases., Brittany L Siontis, Lili Zhao, Monika Leja, Jonathan B Mchugh, Maryann M Shango, Laurence H Baker, Scott M Schuetze, Rashmi Chugh

Articles, Abstracts, and Reports

Introduction: Primary cardiac sarcoma (PCS) has a poor prognosis compared to other sarcomas due to late presentation, challenging resection, incidence of metastases, and limited efficacy of systemic therapies.

Methods: A medical record search engine was queried to identify patients diagnosed with PCS from 1992 to 2017 at the University of Michigan.

Results: Thirty-nine patients with PCS had a median age of 41 years (range 2-77). Common histologies were angiosarcoma (AS, 14), high-grade undifferentiated pleomorphic sarcoma (UPS, 10), and leiomyosarcoma (LMS, 5). Sites of origin were left atrium (18), right atrium (16), and pericardium (5). AS was the most common right-sided …

Initiation Of Action Potential In Murine Ventricular Myocytes By Bursts Of Nanosecond Pulses, Iurii Semenov

Bioelectrics Publications

[First slide] Current situation

I. Among 300,000 persons die from sudden cardiac arrest every year over 40% are victims of fibrillation

II. Defibrillation by an electric shock is the effective therapy against sudden cardiac death

III. Current approach to stop fibrillation may involve disruption of plasma membrane (PM) by an electroporation

IV. Electroporation is damaging, it can: I. Induce post shock arrhythmias II. Complicate patient's recovery III. Lead to death after initially successful resuscitation

Long-Term Use Of Beta-Blocker Medication In Pediatric Long Qt Syndrome Patients: Neuropsychological Profiles, Kara J. Rudisill

PCOM Psychology Dissertations

Long QT syndrome (LQTS) is a heart rhythm disorder characterized by a disruption of the heart’s electrical activity that may cause accelerated and uncontrolled heartbeats referred to as ventricular fibrillation. LQTS is primarily treated with beta-blocker medications, which reduce the risk of experiencing an arrhythmia through regulating the heart rate. However, the potential neuropsychological side-effects associated with the use of beta-blocker medication may impact the executive functioning skills, mental health, and behavior of the affected pediatric population at home. As a result, a child’s academic performance and emotional regulation etiology may be misunderstood by his or her parents, caregivers, and …

Frailty In Patients Undergoing Left Ventricular Assist Device Implantation, Candice Falls

Theses and Dissertations--Nursing

Heart failure is a progressive condition that affects over 5.7 million Americans and costs associated with heart failure account for 2-3 % of the national health care budget. The high rates of morbidity and mortality along with increased costs from readmissions associated with advanced heart failure have led to the exploration of advanced treatments such as left ventricular assist devices (LVADs). LVADS have demonstrated morbidity and mortality benefit but cost remains extensive with costs per quality-adjusted years > $400,000. With this in mind, it is important to identify those who are most likely to benefit from an LVAD to avoid unfavorable …

Elderly Bleeding Risk Of Direct Oral Anticoagulants In Nonvalvular Atrial Fibrillation: A Systematic Review And Meta-Analysis Of Cohort Studies, Jessika Lobraico-Fernandez, Salma Baksh, Eric C. Nemec

Physician Associate Studies Faculty Publications

Introduction The 2014 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines recommend anticoagulation to reduce clot formation and the risk of thromboembolic events in patients with atrial fibrillation but does not specify guidelines for the elderly population. Direct oral anticoagulants (DOACs) are newer US FDA-approved alternatives to warfarin and include dabigatran, rivaroxaban, apixaban and edoxaban. The efficacy of DOACs is heavily researched, but few studies have evaluated their bleeding risk. Objectives This systematic review and meta-analysis investigates which DOAC has the lowest bleeding risk in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods CINAHL and MEDLINE …