Surgery Commons^™

One Love, One Heart – Uniting Cardiac Surgery Programs Within A Network, Lori Fuehrer Rn, Hope L. Johnson Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

Patient Safety In The Cardiac Operating Room: Human Factors And Teamwork: A Scientific Study From The American Heart Association, Joyce A. Wahr, Richard L. Prager, J. H. Abernathy Iii, Elizabeth A. Martinez, Eduardo Salas, Patricia C. Seifert, Robert C. Groom, Bruce D. Spiess, Bruce E. Searles, Thoralf M. Sundt Iii, Juan A. Sanchez, Scott A. Shappell, Michael H. Culig, Elizabeth H. Lazzara, David C. Fitzgerald, Vinod H. Thourani, Pirooz Eghtesady, John S. Ikonomidis, Michael R. England, Frank W. Selke, Nancy A. Nussmeier

Publications

The cardiac surgical operating room (OR) is a complex environment in which highly trained subspecialists interact with each other using sophisticated equipment to care for patients with severe cardiac disease and significant comorbidities. Thousands of patient lives have been saved or significantly improved with the advent of modern cardiac surgery. Indeed, both mortality and morbidity for coronary artery bypass surgery have decreased during the past decade. Nonetheless, the highly skilled and dedicated personnel in cardiac ORs are human and will make errors. Refined techniques, advanced technologies, and enhanced coordination of care have led to significant improvements in cardiac surgery outcomes.

Successful Long-Term Extracorporeal Cardiopulmonary Membrane Oxygenation Without Anti-Coagulation, Janissa Nair, Dorothea T. Watson Do, Rita Pechulis Md, Fccp, Nicholas M. Rini Pa-C, Timothy S. Misselbeck, Kenneth Miller Rrt, James K. Wu Md

Department of Surgery

No abstract provided.

Comparison Of Chronic Persistent And Post-Operative Atrial Fibrillation On Long Term Survival In Patients Undergoing Cardiac Valve Surgery, Nasir Shariff, Ravi V. Desai Md, Sherrine Eid, Michael J. Weiss, Matthew W. Martinez, Sultan M. Siddique, Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Causes Of Death In Surgically Treated Patients With Type A Aortic Dissection - A Ten Year Review, James K. Wu Md, Eilizabeth Depaolo Bs, Theodore G. Phillips Md, Timothy S. Misselbeck

Department of Surgery

No abstract provided.

De-Branching Of The Aortic Arch During Thoracic Endovascular Aortic Repair, James K. Wu Md, Caitlin O'Connor Bs, Timothy S. Misselbeck, Theodore G. Phillips Md

Department of Surgery

No abstract provided.

Conventional Isolated Aortic Valve Replacement In Octogenarians: A 10-Year Single Center Experience, James K. Wu Md, Justin D. Roberts Do, Gregory S. Troutman Bs, Michael J. Weiss Mph, Sanjay M. Mehta Md, Theodore G. Phillips Md, Michael F. Szwerc Md, Gary W. Szydlowski Md, Timothy S. Misselbeck, Raymond L. Singer Md

Department of Surgery

No abstract provided.

Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas C. Cavarocchi, Paul Mather

Department of Surgery Faculty Papers

This is invited commentary to the following article:

Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Spontaneous Coronary Artery Dissection: A Rare But Deadly Cause Of Acs In Younger Patients, Daniel J. Makowski Do, David A. Cox Md

Department of Medicine

No abstract provided.

Infectious Intracranial Aneurysms: Collaboration For Treatment Success, Erin M. Conahan Rn, Bsn, Cnrn

Patient Care Services / Nursing

No abstract provided.

Critical Assessment Of Outcomes In Acute Aortic Dissection (Type A) At A Community Hospital: A 10 Year Review, Timothy S. Misselbeck, James K. Wu Md, Stephen Deturk Ba, Michael F. Szwerc Md, Sanjay M. Mehta Md, Theodore G. Phillips Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Department of Surgery

No abstract provided.

Earlier Surgical Intervention In Congenital Heart Disease Results In Better Outcome And Resource Utilization, Roheena Z. Panni, Awais Ashfaq, Muhammad M. Amanullah

Section of Cardiothoracic Surgery

Background:Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively, among Patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan.

Methods:

A prevalence based cost of illness Study Design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children Results:The mean age at the time of surgery in group …

Adherence To The European Society Of Cardiology (Esc) Guidelines For Chronic Heart Failure - A National Survey Of The Cardiologists In Pakistan, Sana Shoukat, Saqib A. Gowani, Ather M. Taqui, Rameez Ul Hassan, Zain A. Bhutta, Anum I. Malik, Sajjad A. Sherjeel, Quratulanne Sheheryar, Sajid H. Dhakam

Section of Neurosurgery

Background:The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines.
Methods: A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management …

Surgical Correction Of Aorto-Pulmonary Window: A Rare And Lethal Cause Of Pulmonary Hypertension, Adeel Ahmed Shamim, Mubashir Zareen Khan, Mehnaz Ahmed Atiq, Mansoor Ahmed Khan, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

Aorto-pulmonary window is a relatively rare congenital cardiac malformation with an overall incidence of 0.1%. Pulmonary hypertension develops quickly if the lesion is left untreated hence early surgical intervention is warranted after diagnosis. The surgery for correction of APW has evolved over years, currently an open repair on cardiopulmonary bypass (CPB) with a single patch technique yields good results. Mortality is affected by association of pulmonary hypertension and other cardiac malformations. We present a case of an infant with a large type II APW with a relatively low pulmonary vascular resistance. Hospital stay was complicated because of pulmonary arterial disease …

Ganglioneuroblastoma Of The Posterior Mediastinum: A Case Report., Saulat Fatimi, Samira A Bawany, Awais Ashfaq

Section of Cardiothoracic Surgery

Introduction:Ganglioneuroblastoma is a rare peripheral neuroblastic tumor that is derived from developing neuronal cells of the sympathetic nervous system, and is found mostly, but not exclusively, in babies and young children.

Case Presentation:

To the best of our knowledge, there have been no previously reported cases of ganglioneuroblastoma of the mediastinum from Pakistan. We present a case of ganglioneuroblastoma in an eight-year-old Pakistani Sindhi boy incidentally found to have a large posterior mediastinal mass that on biopsy initially looked like ganglioneuroma. He underwent successful excision of the mediastinal mass and remained stable post-operatively. Final pathology findings showed a ganglioneuroblastoma. …

Bapcap2-1 Does Preoperative Aspirin Improve Outcomes In Cardiac Surgery Patients?, Jian-Zhong Sun, L. Cao, H. Liu, W. Sun, S Silvestry, J. Diehl

Department of Anesthesiology Faculty Papers

Best Abstracts - Runner-up Session 2 presented at Euroanaesthesia 2011 in the Netherlands.

Background and Goal of Study: The effects of preoperative aspirin on major cardiocerebral and renal outcomes and mortality remain uncertain.

Surgical Management Of Complete Atrioventricular Septal Defect: Associations With Surgical Technique, Age, And Trisomy 21., Andrew M. Atz, John A. Hawkins, Minmin Lu, Meryl S. Cohen, Steven D. Colan, James Jaggers, Ronald V. Lacro, Brian W. Mccrindle, Renee Margossian, Ralph S. Mosca, Lynn A. Sleeper, L Luann Minich, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: We sought to evaluate the contemporary results after repair of a complete atrioventricular septal defect and to determine the factors associated with suboptimal outcomes.

METHODS: The demographic, procedural, and outcome data were obtained within 1 and 6 months after repair of a complete atrioventricular septal defect in 120 children in a multicenter observational study from June 2004 to 2006.

RESULTS: The median age at surgery was 3.7 months (range, 9 days to 1.1 years). The type of surgical repair was a single patch (18%), double patch (72%), and a single atrial septal defect patch with primary ventricular septal defect …

Risk Factors Affecting Outcomes In Patients Undergoing Hypothermic Circulatory Arrest During Aortic Surgeries, Bree Ann Young, James K. Wu Md, Martin E. Matsumura Md, Timothy S. Misselbeck, Sanjay M. Mehta Md, Theodore G. Phillips Md, Michael F. Szwerc Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Department of Surgery

No abstract provided.

Treatment Of Acute Aortic Dissection At A Community Hospital: A 10 Year Review Of Outcomes., Timothy S. Misselbeck, Stephen Deturk, Matthew Wilson, Theodore Phillips Md, Michael Szwerc Md, Sanjay Mehta Md, Gary Szydlowski Md, Raymond Singer Md, James Wu Md

Department of Surgery

No abstract provided.

Risk Factors Affecting Surgical Outcomes In Patients Undergoing Hypothermic Circulatory Arrest During Aortic Surgeries: A 10-Year Study, Bree Ann Young, James K. Wu, Martin E. Matsumura Md, Sanjay M. Mehta Md, Theodore G. Phillips Md, Michael F. Szwerc Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Department of Medicine

No abstract provided.

Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan

Section of Cardiothoracic Surgery

In Europe and North America, cardiac surgery can be done successfully on octogenarians, but differences in patient selection, surgical and bypass techniques prevent us from concluding similarly in Pakistan. This study investigated the short and long-term outcomes of cardiac surgery in octogenarians operated over a 5 years period at The Aga Khan University Hospital, from January 2001 to December 2006. Seventeen octogenarians, (mean age 81.7 ± 2.3) underwent coronary artery bypass graft (CABG). Thirty-days hospital mortality was reported in only 1 patient. Surgical complication of any kind was reported in 13 (76.5%) patients with pleural effusion being the commonest in …

Initial Experience With A Miniaturized Multiplane Transesophageal Probe In Small Infants Undergoing Cardiac Operations., Sinai C. Zyblewski, Girish S. Shirali, Geoffrey A. Forbus, Tain-Yen Hsia, Scott M. Bradley, Andrew M. Atz, Meryl S. Cohen, Eric M. Graham

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: There has been reluctance to use intraoperative transesophageal echocardiography (TEE) in small infants. We assessed the utility and safety of a new miniaturized multiplane micro-TEE probe in small infants undergoing cardiac operations.

DESCRIPTION: Hemodynamic and ventilation variables were prospectively recorded before and after micro-TEE insertion and removal in infants weighing 5 kg or less undergoing cardiac operations.

EVALUATION: The study included 42 patients with a mean weight of 3.6 +/- 0.9 kg (range, 1.7 to 5 kg). All probe insertions were successful. There were no complications or clinically significant changes in hemodynamic or ventilation variables. Information provided by TEE …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Partial And Transitional Atrioventricular Septal Defect Outcomes., L Luann Minich, Andrew M. Atz, Steven D. Colan, Lynn A. Sleeper, Seema Mital, James Jaggers, Renee Margossian, Ashwin Prakash, Jennifer S. Li, Meryl S. Cohen, Ronald V. Lacro, Gloria L. Klein, John A. Hawkins, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.

METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.

RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive …

Outcome Of Traumatic Aortic Rupture: A 14-Year Experience, Matthew Wilson, James K. Wu, Sanjay M. Mehta Md, Theodore G. Phillips Md, Raymond L. Singer Md, Michael F. Szwerc Md, Gary W. Szydlowski Md

Department of Medicine

No abstract provided.

Parent- Versus Child-Reported Functional Health Status After The Fontan Procedure., Linda M. Lambert, L Luann Minich, Jane W. Newburger, Minmin Lu, Victoria L. Pemberton, Ellen A. Mcgrath, Andrew M. Atz, Mingfen Xu, Elizabeth Radojewski, Darlene Servedio, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: We sought to compare perceptions of functional health status between children who had undergone a Fontan procedure and their parents.

METHODS: Fontan procedure survivors 10 to 18 years of age were included in the study if the child completed the Child Health Questionnaire (CHQ) and the parent completed the parent form to assess the child's functional health status. Comparisons were made between raw domain scores for the parent- and child-completed CHQs.

RESULTS: Between March 2003 and April 2004, 1078 Fontan survivors were screened. Of the 546 eligible and consented patients, 354 were 10-18 years of age and 328 parent/child …

Functional State Following The Fontan Procedure., Ismee A. Williams, Lynn A. Sleeper, Steven D. Colan, Minmin Lu, Elizabeth A. Stephenson, Jane W. Newburger, Welton M. Gersony, Meryl S. Cohen, James F. Cnota, Andrew M. Atz, Richard V. Williams, Renee Margossian, Andrew J. Powell, Mario P. Stylianou, Daphne T. Hsu, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function.

METHODS AND RESULTS: We analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by …

The Pakistan Risk Of Myocardial Infarction Study: A Resource For The Study Of Genetic, Lifestyle And Other Determinants Of Myocardial Infarction In South Asia, Danish Saleheen, Moazzam Zaidi, Asif Rasheed, Usman Ahmad, Abdul Hakeem, Muhammed Murtaza, Waleed Kayani, Rashid Jooma, Nadir Khan, Nabi Shah, Asad Ali Shah, Maria Samuel, Farina Hanif, Madiha Yameen, Sobia Naz, Aisha Sultana, Aisha Nazir, Shehzad Raza, Muhammad Shazad, Sana Nasim, Muhammad Ahsan Javed, Syed Saadat Ali, Mehmood Jafree, Muhammad Imran Nisar, Altaf Hussain, Ayeesha Kamran Kamal, Philippe M. Frossard

Department of Biological & Biomedical Sciences

The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30-80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a …

Fatal Transfusion Related Acute Lung Injury Following Coronary Artery By-Pass Surgery: A Case Report., Fauzia Ahmad Bawany, Hasanat Sharif

Section of Cardiothoracic Surgery

Background:Transfusion related acute lung injury (TRALI) is a potentially fatal Acute Lung Injury following transfusion of blood components. Hypotheses implicate donor-derived anti-human leukocyte antigen or granulocyte antibodies reacting with recipients' leukocytes, releasing inflammatory mediators. Lack of agreement on underlying cellular and molecular mechanisms renders improving transfusion safety difficult and expensive.

Case Presentation:

Literature search has not revealed any case of TRALI from Pakistan. We report the case of fatal TRALI in a 68 year old male who received blood products after coronary artery by-pass surgery.

Conclusion:

This article aims to create awareness about this complication and suggests that post …

Design And Rationale Of A Randomized Trial Comparing The Blalock-Taussig And Right Ventricle-Pulmonary Artery Shunts In The Norwood Procedure., Richard G. Ohye, J William Gaynor, Nancy S. Ghanayem, Caren S. Goldberg, Peter C. Laussen, Peter C. Frommelt, Jane W. Newburger, Gail D. Pearson, Sarah Tabbutt, Gil Wernovsky, Lisa M. Wruck, Andrew M. Atz, Steve D. Colan, James Jaggers, Brian W. Mccrindle, Ashwin Prakash, Michael D. Puchalski, Lynn A. Sleeper, Mario P. Stylianou, Lynn Mahony, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The initial palliative procedure for patients born with hypoplastic left heart syndrome and related single right ventricle anomalies, the Norwood procedure, remains among the highest risk procedures in congenital heart surgery. The classic Norwood procedure provides pulmonary blood flow with a modified Blalock-Taussig shunt. Improved outcomes have been reported in a few small, nonrandomized studies of a modification of the Norwood procedure that uses a right ventricle-pulmonary artery shunt to provide pulmonary blood flow. Other nonrandomized studies have shown no differences between the two techniques.

METHODS: The Pediatric Heart Network designed a randomized clinical trial to compare outcomes for …