Surgery Commons^™

Predicting Trauma Admission In Anticoagulated Geriatric Patients Presenting With A Ground Level Fall, Y-Nhi H. Bui Ms, Trevor Glad Bmus, Dylan Jack Bs, Michael Martyak

Knowledge and Creativity Expo

Our study undertook a rigorous investigation into an expanding trauma patient population, tackling some of the significant challenges with this patient population in trauma triage. Our research has not only addressed key questions, but has also paved the way for future inquiries by offering innovative perspectives. This presentation is particularly important given the current advancements and interests in geriatric trauma. We hope that our findings will influence ongoing projects and spark collaborations among diverse research communities.

Concomitant Subacromial Decompression Remains Commonly Performed During Rotator Cuff Repair: A Trinetx Study, Madison Baldauf, Zachary Krumm, Savannah Ward, Katherine Worcester, Kevin Bonner Md

Knowledge and Creativity Expo

Introduction:

Arthroscopic rotator cuff repair (RCR) is among the most frequently performed shoulder procedures in the US and is often accompanied by concomitant subacromial decompression (SAD). In recent years some studies have called into question the benefit of SAD in this setting. The topic is controversial as many surgeons still feel SAD is indicated. This study aims to characterize the changes in proportion of SAD performed concomitantly with RCR over recent years using TriNetX.

Methods:

The TriNetX database was queried for all patients undergoing arthroscopic rotator cuff repair from 2013 to 2025. Cohorts were established using the Current Procedural Terminology …

Extracorporeal Membrane Oxygenation In Trauma Before And After Covid-19: Associations Of Utilization, Timing, And Outcomes, Ryan Mancoll, William Rice, Theodore Chin, Grayson Mast M.D, Samantha Olafson M.D.

Knowledge and Creativity Expo

Objectives:

The COVID-19 pandemic expanded and altered general ECMO utilization and provider experience; however, any impact on trauma-specific ECMO practice following this shift remains unclear. We hypothesize that trauma ECMO utilization patterns, timing of initiation, and outcomes have differed following COVID-19.

Methods:

We conducted a retrospective cohort study of trauma patients receiving ECMO (2017-2024) using the American College of Surgeons Trauma Quality Improvement Program (TQIP) Participant Use Files. The primary exposure was the COVID era (2017-2019 vs. 2021-2024). Primary outcomes included ECMO utilization, time to initiation, and in-hospital mortality; secondary outcomes included discharge disposition, major complications, and length of stay …

Turnover Time In Neuroangiography Suites: Comparison Between Cases Performed At An Ambulatory Neurosurgery Center Versus A Tertiary Hospital, Pui Man Rosalind Lai, Vinay Jaikumar, Erika L. Leasher, Varun Sridhar, Gustavo M. Cortez, Aimee C. Degaetano, Elad I. Levy

EVMS School of Health Professions Faculty Publications

Background:

Efficient turnover time (TOT) and adherence to first-start time (FST) in operating and angiography suites are critical for optimizing workflow, reducing costs, and maximizing patient satisfaction. Hospitals face challenges in maintaining these metrics due to operational constraints and unexpected emergent cases. Our goal was to compare TOT, FST, and total admission time for elective cases performed in angiography suites at an ambulatory neurosurgery center (ANSC) versus a tertiary hospital (TH).

Methods:

We conducted a retrospective analysis of data for patients who underwent elective diagnostic or interventional neuroendovascular procedures at the TH or ANSC from January 2024 through October 2024. …

Successful Use Of Chimeric Antigen Receptor T-Cell (Car-T) Therapy With Lisocabtagene Maraleucel In A Renal Transplant Recipient With Refractory/Relapsed Diffuse Large B-Cell Lymphoma (Dlbcl), Waqqas Tai, Fatima Chaudhry, Nesreen Shahrour, Jessica Thomas, Afoma Anyadibe, Anuoluwa Oyetoran, Swathi Gopishetty, Precious Idogun, Dilip Samarapungavan, Jassim H. Sarmad, Ishmael Jaiyesimi

Department of Medicine Faculty Publications

This case describes a 53-year-old male with end-stage renal disease who developed monomorphic post-transplant lymphoproliferative disorder (PTLD) in the form of diffuse large B-cell lymphoma (DLBCL) after kidney transplantation. Despite initial treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP), the patient's disease progressed, and he was referred for chimeric antigen receptor (CAR) T-cell therapy with lisocabtagene maraleucel (liso-cel). Given his post-transplant status, his immunosuppressive agents (tacrolimus and mycophenolate) were held, and prednisone was tapered to 5 mg daily to maintain minimal baseline immunosuppression. After lymphodepleting chemotherapy and liso-cel infusion, the patient experienced no significant toxicities, including cytokine release syndrome (CRS) …

Percutaneous Closure Of Ventricular Septal Rupture After Myocardial Infarction:, Thomas A. Cook, Simone K. Schumaecker, Anjani Patibandla, Nicholas J. Valle, Matthew R. Summers

Department of Medicine Faculty Publications

BACKGROUND: Ventricular septal rupture (VSR) following acute myocardial infarction is a rare but deadly complication with mortality rates exceeding 90% when left untreated. Coronary ischaemia leads to myocardial necrosis and friability resulting in septal rupture, most commonly 3-5 days post-infarction. The sudden development of a left-to-right shunt causes volume overload in the right ventricle, pulmonary vasculature, and left atrium, precipitating biventricular failure, and cardiogenic shock. Management requires careful consideration of timing and modality of closure along with stabilization with mechanical circulatory support in severe cases.

CASE SUMMARY: A 65-year-old female presented with anterior ST-segment elevation myocardial infarction complicated by VSR …

Editor's Choice - International Expert Consensus On The Management Of Acute Aortic Type B Intramural Haematoma And Penetrating Ulcer, Francesco Squizzato, Mario D'Oria, Michele Antonello, Santi Trimarchi, Kevin Mani, Andrew Holden, Tilo Kölbel, Stephan Haulon, Eric Verhoeven, Dittmar Böckler, Tim Resch, Ali Azizzadeh, Joseph Lombardi, Michele Piazza, Aaron Thomas Fargion, Alexander Zimmerman, Ali Azizzadeh, Anders Wanhainen, Andrew Holden, Antonio Freyrie, Adam W. Beck, Adi Bachar, Barend M. E. Mees, Blandine Maurel, Cristoph A. Nienaber, Christos Karkos, Daniela Branzan, Darren Schneider, Randall Demartino, Dittmar Boeckler, Domenico Angiletta, Emanuel J. R. Tenorio, Enrico Gallitto, Eric Verhoeven, Fabio Verzini, Felice Pecoraro, Filippo Benedetto, Firas F. Mussa, Francesco Squizzato, Franco Grego, Gabriele Piffaretti, Emanuele Gatta, Giovanni Pratesi, Giovanni Tinelli, Giuseppe Asciutto, Glenn Wei Leong Tan, Hence Verhagen, Giacomo Isernia, Jean-Paul P. M. De Vries, Jacob Budtz-Lilly, Jorge Fernández-Noya, Jonathan Sobocinski, Joseph Hockley, Kak Khee Yeung, Andrea Kahlberg, Kevin Mani, Joseph V. Lombardi, Luca Bertoglio, Luca Mezzetto, Ludovic Canaud, Manar Khashram, Marcelo Ferreira, Marco Virgilio Usai, Mark G. Davies, Mark Farber, Martin Czerny, Matthew R. Smeds, Mauro Gargiulo, Germano Melissano, Michel Bosiers, Michele Antonello, Michele Piazza, Miranda Witheford, Michel M.P.J. Reijnen, Marc Schermerhorn, Nikolaos Tsilimparis, Nun Dias, Jean Panneton, Kosmas Paraskevas, Gianbattista Parlani, Patrick W.H.E. Vriens, Rafael Malgor, Raffaele Pulli, Ross Milner, Salvatore T. Scali, Sani J. Laukontaus, Santi Trimarchi, Sandro Lepidi, Konstantinos Spanos, Stefano Fazzini, Theodosios Bisdas, Thomas Maldonado, Tilo Koelbel, Tim Resch, Tomasz Jakimowicz, Nicola Troisi, Isabelle Van Herzeele, Vicente Riambau, Wassim Mansour, Wouter Van Den Eynde, Yamume Tshomba

Department Surgery Faculty Publications

Objective

The aim of this study was to achieve an international expert consensus on managing acute type B penetrating aortic ulcers (PAUs) and intramural haematomas (IMHs).

Methods

A modified Delphi consensus process was employed to develop recommendations for the management of acute type B PAU and IMH. Surveys were sent to international experts practicing in high volume aortic centres worldwide. Statements were voted on using a four point Likert scale in a three round Delphi process. Statements achieving grade A (full agreement 75%) or B (overall agreement 80%, full disagreement <  5%) were included as expert recommendations. Consistency of responses was measured using Cohen's κ and the intraclass correlation coefficient.

Results

Eighty three experts were included in the final analysis: …

Endovascular Arch Repair Using A Novel Single Branch Arch Stent Graft: 30-Day Results From The Chronic Dissection Arm Of The Nexus Aortic Arch Clinical Study To Evaluate Safety And Effectiveness Investigational Device Exemption Study, Bradley G. Leshnower, Jean Panneton, Himanshu J. Patel, Adam W. Beck, Mathew Wooster, Kyle W. Eudailey, Shinichi Fukuhara, Jae Cho, Sanford Zeigler, Westley Ohman, Puja Kachroo, Derek Brinster, Shahab Toursavadkohi, Mehrdad Ghoreishi, Brandley Taylor, Frank Arko, Paul Hayes, Ross Milner

Department Surgery Faculty Publications

Objective

Moderate levels of frailty or a previous sternotomy make open repair of aortic arch pathology high risk or even preclude any treatment. This study examined 30-day outcomes from the NEXUS Aortic Arch Clinical Study to Evaluate Safety and Effectiveness investigational device exemption (TRIOMPHE IDE) study of an off-the-shelf stent-graft system for Zone 0 endovascular aortic arch repair in patients with high-risk chronic dissection.

Methods

TRIOMPHE IDE is a prospective, multicenter study evaluating the NEXUS system (Endospan) in chronic aortic dissection (n = 54). Following cervical debranching, NEXUS was delivered into the arch first, followed by an ascending aortic stent-graft. …

Migration Of Copper Bullet Fragment Through The Orbit And Conjunctiva, Maxwell A. Levi, Mehron G. Kouhestani, Giovanni Disandro, Peter A. Netland

Department of Ophthalmology Faculty Publications

This is a case report of a 31-year-old female who sustained a gunshot wound to the left orbit, resulting in a ruptured globe and retained bullet fragments extending into the frontal lobe. The patient underwent enucleation without orbital implant, and no metallic fragments were recovered intraoperatively. Three months later, she returned with bloody conjunctival discharge. Examination revealed a 1.25-cm copper-colored metallic bullet jacket fragment spontaneously protruding through the conjunctiva. Serial CT imaging confirmed anterior and inferior migration of the bullet fragment over time, with a total migration distance of 32.9 mm through the orbit. The shrapnel was removed in clinic …

Occupational Human Papillomavirus Exposure Risks For Laryngeal Surgeons And Phoniatricians: A Joint European Laryngological Society (Els) And Union Of European Phoniatricians (Uep) Delphi Clinical Consensus Statement, Shiying Hey, Alberto Maria Saibene, Milan Amin, Jennifer Anderson, Christoph Arens, Simon Best, Guillermo Campos, Craig Derkay, Gauthier Desuter, Frederik G. Dikkers, Isabel Garcia-Lopez, Ahmed Geneid, Anastasios Hantzakos, Markus Hess, Yakubu Karagama, Marina Mat Baki, Napur Kapoor Nerurkar, Daniel Novakovic, Haldun Oguz, Shazia Peer, Jasmine Prasad, Carlo Robotti, David Vokes, Chi-Te Wang, Malgorzata Wierzbicka, Michal Zabrodsky, Nicolien Van Der Poel

Department of Otolaryngology (ENT) Faculty Publications

Purpose

Laser surgical management of human papillomavirus (HPV)-related disease, such as recurrent respiratory papillomatosis (RRP), in the upper aerodigestive tract generates surgical smoke, which may represent a source of occupational viral exposure for laryngeal surgeons, phoniatricians, anesthesia providers and scrub nurses. Despite growing awareness, protective measures remain inconsistently implemented. This study aimed to develop an evidence-informed clinical consensus statement (CCS) to guide occupational HPV risk management in laryngology.

Methods

A modified Delphi consensus process was conducted under the auspices of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP). A panel of 26 international experts undertook …

Leveraging Virtual Reality And Haptics To Teach Surgical Skills: A Usability Study On Retropubic Midurethral Slings, Lauren Siff, Ginger S. Watson, Jerome Dixon, Moshe Feldman, Franklin Bost, Philippe J. Giabbanelli

VMASC Publications

Traditional methods to learn soft-tissue surgical procedures rely on cadaver labs or patient-based learning, which are costly and geographically limited, and raise ethical questions. Virtual reality (VR) with haptic feedback offers a scalable alternative, but most current platforms emphasize bone-based rather than soft-tissue procedures learned by feel. We developed a VR+haptic simulation for preoperative training of retropubic midurethral sling (MUS) surgery. This study examines the usability of this platform with thirteen expert urogynecologic surgeons and subsequently makes improvements (e.g., in haptics) to evaluate the platform with twelve trainees based on the NASA Task Load Index for workload and a UTAUT-informed …

Radial And Carotid Arterial Pulse Signals For Assessing Cardiovascular Function At Rest And During Post-Exercise Recovery In A Heart Transplant Patient: A Case Study, Md Mahfuzur Rahman, Mamun Hasan, Jennifer F. May, John M. Herre, Leryn Reynolds, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

Aim: This study investigates the feasibility of using radial and carotid arterial pulse signals to assess cardiovascular (CV) function at rest and during post-exercise recovery in a heart transplant (HTx) patient. Method: Two micro-fabricated tactile sensors were used to simultaneously acquire arterial pulse signals at the radial artery (RA) and carotid artery (CA). Measurements were taken at rest and at multiple time points post-exercise on three subjects: an HTx patient, a percutaneous coronary intervention (PCI; coronary stent) patient and a healthy control. An SDOF-TF-based time-frequency analysis algorithm was applied to extract a comprehensive set of CV parameters, including heart rate …

Enhancing Graduate Surgical Education: Recommendations For Development Of Common Surgery Education And Training Accreditation Standards, Edwin Christopher Ellison, David B. Hoyt, L. D. Britt, Gerald B. Healy, John R. Potts Iii, Michael M. Awad, Eric A. Gantwerker, Apostolos Gaitanidis, Carol R. Bradford, Robert Phillip Burns, Mary T. Hawn, John G. Hunter, Cheryl T. Lee, Keith D. Lillemoe, Najjia N. Mahmoud, Jeffrey B. Matthews, Michael W. Neumeister, Kathleen C. Y. Sie, The Independent Committee For Graduate Surgical Education

Department Surgery Faculty Publications

Background:

Concerns persist within the surgical community that completion of an accredited surgical residency no longer consistently ensures that trainees are ready for independent practice. In response, the Independent Committee for Graduate Surgical Education (ICGSE) was established in January 2025 to address the unique requirements of surgical training. The committee’s mandate was to recommend program standards that would potentially optimize education and training for surgical residents, with the goal of improving patient care.

Methods:

The ICGSE, consisting of 71 surgeons across 16 specialties, reviewed the history of surgical accreditation and relevant literature. Workgroup-led discussions identified strategies for improving trainee readiness …

Prognostic Factors For Patients Under 45 Undergoing Surgery For Colorectal Liver Metastases: A Seer Population-Based Study, Gabrielle Grob, Fang Fang, Matvey Karpov, Eric Feliberti, Marybeth Hughes, Rachel Burke, Winifred Lo

Department Surgery Faculty Publications

Background and Objectives: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The aim of this study was to describe patient and tumor characteristics associated with disease-specific survival in young patients (<  45 years) versus older patients (≥ 45 years) with isolated CRLM.

Methods: The SEER database was queried for patients with CRLM who underwent colon and liver resection from 2010 to 2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. Cox regression was used to analyze demographic factors, tumor …

Indirect Treatment Comparison Of Tezepelumab Versus Other Biologics In Severe Chronic Rhinosinusitis With Nasal Polyps: A Systematic Literature Review And Network Meta-Analysis, Joseph K. Han, Joaquim Mullol, Claire Hopkins, Oliver Pfaar, Martin Desrosiers, Jason Steenkamp, Danny Gibson, Santiago Zuluaga Sanchez, Andrew Foster, Christopher S. Ambrose

Department of Otolaryngology (ENT) Faculty Publications

Introduction

This study compared the efficacy of tezepelumab with other approved biologics and endoscopic sinus surgery (ESS) using indirect treatment comparisons (ITCs) in adults with severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods

Randomized controlled trials (RCTs) identified via a systematic literature review (SLR) were synthesized in a network meta-analysis (NMA). Outcomes included change from baseline in nasal polyp score (NPS), nasal congestion/obstruction score (NCS/NOS), difficulty with sense of smell (DSS), Sino-Nasal Outcome Test-22 (SNOT-22) score, Lund Mackay score (LMS), time to nasal polyposis (NP) surgery decision, proportions requiring NP surgery or systemic corticosteroids (SCS), time to SCS use, …

Ocular Surface Disease Following Lasik And Cataract Surgery: A Review Of Their Interrelated Complications, Matthew D. Spangler, Nila Kirupaharan, John D. Sheppard

Department of Ophthalmology Faculty Publications

Background: Ocular surface disease is a multifactorial condition that is very commonly caused by dry eye disease (DED). Ophthalmic procedures intended to improve visual outcomes, laser-assisted in situ keratomileusis (LASIK) and cataract surgery, can paradoxically cause or exacerbate underlying ocular surface disease. This results in worsening vision and quality of life.

Areas covered: This review examines the pathophysiological mechanisms contributing to ocular surface disease development following LASIK and cataract surgery. Both procedures are associated with the transection of corneal nerves, leading to decreased tear production, surface instability, altered neurotrophin production, and impairment of the blink reflex. Furthermore, these incisional procedures …

Outcomes Of Allogeneic Ocular Surface Stem Cell Transplantation, Albert Y. Cheung, Natalia Quiroz-Casian, Enrica Sarnicola, Gautam C. Ramanathan, Siddharth Nath, Edward J. Holland

Department of Ophthalmology Faculty Publications

Allogeneic ocular surface stem cell transplantation (OSST) is an established therapeutic approach for limbal stem cell deficiency, utilizing techniques such as keratolimbal allograft (KLAL), living-related conjunctival limbal allograft (lr-CLAL), allogeneic cultivated limbal epithelial transplantation (allo-CLET), and allogeneic simple limbal epithelial transplantation (allo-SLET). This review synthesizes evidence from 35 studies encompassing 1, 268 eyes with at least 24 months of follow-up to evaluate intermediate- and long-term outcomes. Overall, OSST is associated with improvement in visual acuity and restoration of ocular surface stability, although success rates vary widely by technique, ranging from 13% to 87%. Outcomes appear to be influenced by the …

Donor-Derived Cell-Free Dna In Antibody-Mediated Rejection: An Analysis Of The Surveillance Heartcare Outcomes Registry, Paul J. Kim, Amit H. Alam, Jeffrey J. Teuteberg, Kiran K. Khush, Sean P. Pinney, Richard K. Cheng, Amin Yehya, Jeremy Kobulnik, Kevin M. Pinney, Kris A. Oreschak, Christopher R. Ensor Pharmd, Steven Fan, Marcus A. Urey, Palak Shah, Shelley A. Hall

Department of Medicine Faculty Publications

Background

Donor-derived cell-free DNA (dd-cfDNA) has emerged as a biomarker for antibody-mediated rejection (AMR), but its performance characteristics have not been evaluated in a large contemporary heart transplant population.

Objectives

The study aimed to characterize the incidence and timing of biopsy-proven AMR and evaluate the performance characteristics of dd-cfDNA for AMR.

Methods

The authors included 2,240 subjects from the SHORE (Surveillance HeartCare Outcomes Registry) registry transplanted between 2017 and 2022 with verified biopsy, dd-cfDNA, echocardiographic, and donor-specific antibody (DSA) data. They evaluated the performance characteristics of dd-cfDNA for AMR and the incidence of AMR in different clinical contexts.

Results

AMR …

Intraoperative Positioning System-Guided Antegrade In Situ Laser Fenestration In An Aortic Model, Emily Burnett, Emidio Germano, Allie Olmstead, Benjamin Samberg, Robert Meisner, Hannah Hofacker, Michael Bronez, Vikash Goel, Animesh Rathore

Department of Medicine Faculty Publications

Objective

Fenestrated endovascular aneurysm repair (fEVAR) is routinely being used for visceral vessel incorporation in complex aneurysmal pathology; however, it is associated with prolonged procedure times, high radiation exposure, high contrast use, and multiple staged procedures. To combat these limitations, Centerline Biomedical developed the three-dimensional surgical navigation and visualization technology: intraoperative positioning system (IOPS). We previously presented our IOPS-guided antegrade in situ laser fenestration in a standard aortic model. This case report details our experience using IOPS guidance during a fEVAR procedure in a representative thoracoabdominal aortic aneurysm phantom model.

Methods

A silicone thoracoabdominal aortic segment was three-dimensional printed based …

A Comprehensive Review Of Bone Remodeling After Trauma And Operative Treatment In Orthopedic Surgery, Sarah E. Rabin, Ian P. Marshall, Benjamin A. Nelson, Justine N. Li, Madison M. Baldauf, Ashley B. Bozzay, Benjamin W. Hoyt

Department of Medicine Faculty Publications

Bone remodeling is a dynamic process involving bone resorption and formation that is regulated on a cellular level and impacted by mechanical stress. A variety of Orthopedic surgery treatment strategies can affect bone remodeling, which can in turn may have long-term impacts on skeletal stress tolerance and function. This review provides a comprehensive overview of bone remodeling involved in Orthopedic surgery. Materials related to bone remodeling principles across Orthopedic surgery domains were selected and compiled using databases including PubMed, MEDLINE, AccessMedicine, and CINAHL; case studies were not included. Relevant literature was summarized for a general review of bone remodeling and …

Concomitant Transcatheter Edge-To-Edge Repair For Mitral And Tricuspid Regurgitation For Polyvalvular Disease, Omar Khan, Matthew Summers

Department of Medicine Faculty Publications

This patient is a 77-year-old male with non-ischemic cardiomyopathy, severe tricuspid regurgitation, and moderate mitral regurgitation who underwent simultaneous transcatheter edge-to-edge repair of both mitral and tricuspid valves. Post-procedure, the patient exhibited significant symptomatic improvement and reduced regurgitation severity, highlighting the feasibility of dual-valve TEER in high-risk patients.

Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Incidence, Predictors, And Association With Reduced Ischemic Stroke Risk, Omar Saleh, Nicholas J. Valle, Shinjer Li, Saleh Mostafa, Israa Saleh, Raymond Benza, Deepak R. Talreja, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Development of conduction abnormalities requiring pacing after transcatheter aortic valve replacement (TAVR) is relatively common. The effects of post-TAVR permanent pacemaker (PPM) implantation on mortality, ischemic stroke, and cardiovascular outcomes remain incompletely characterized. AIMS: To evaluate the incidence, predictors, and cardiovascular outcomes of post-TAVR permanent pacemaker implantation, including its association with 1-year ischemic stroke risk.

Methods

Adults undergoing TAVR (2008-2019; n = 1101) were evaluated. Patients with prior PPM (n = 104) and/or valve-in-valve or redo TAVR (n = 11) were excluded. PPM placement was identified post-indexed TAVR admission based on procedure codes, including both in-hospital and post-discharge implantations. …

Combined Snare And Buddy-Balloon Strategy For Failed Valve Crossing In Valve-In-Valve Transcatheter Aortic Valve Replacement, Hira Sarfraz, Muhammad U. Javed, Parth K. Parikh, Joshua A. Cohen, Raymond L. Benza, Matthew R. Summers, Deepak R. Talreja

Department of Medicine Faculty Publications

Background Retrograde valve crossing during valve-in-valve transcatheter aortic valve replacement (ViV TAVR) may fail despite modern delivery systems. Case Summary A 67-year-old man with a degenerated 27-mm Magna Ease bioprosthesis and unfavorable aortic geometry (kinked ascending aorta at a prior surgical graft site) underwent ViV TAVR, where retrograde valve crossing failed despite multiple stiff guidewires and snare traction alone. Successful delivery of a 29-mm Evolut FX+ was ultimately achieved by combining gooseneck-snare traction for coaxial realignment with a partially inflated Tyshak buddy balloon acting as a mechanical ramp across the surgical valve frame. Discussion This case demonstrates a structured, stepwise …

Combined Snare And Buddy-Balloon Strategy For Failed Valve Crossing In Valve-In-Valve Transcatheter Aortic Valve Replacement, Hira Sarfraz, Muhammad U. Javed, Parth K. Parikh, Joshua A. Cohen, Raymond L. Benza, Matthew R. Summers, Deepak R. Talreja

Department of Medicine Faculty Publications

Background

Retrograde valve crossing during valve-in-valve transcatheter aortic valve replacement (ViV TAVR) may fail despite modern delivery systems.

Case Summary

A 67-year-old man with a degenerated 27-mm Magna Ease bioprosthesis and unfavorable aortic geometry (kinked ascending aorta at a prior surgical graft site) underwent ViV TAVR, where retrograde valve crossing failed despite multiple stiff guidewires and snare traction alone. Successful delivery of a 29-mm Evolut FX+ was ultimately achieved by combining gooseneck-snare traction for coaxial realignment with a partially inflated Tyshak buddy balloon acting as a mechanical ramp across the surgical valve frame.

Discussion

This case demonstrates a structured, stepwise …

Complicated Third Sternotomy For Left Ventricular Outflow Tract Obstruction Secondary To Mitral Valve Prosthesis Strut, Rishab Agarwal, Alleabelle Bradshaw, Michelle Carvajal, Jennifer S. Lawton

Department of Medicine Faculty Publications

Introduction: LVOT obstruction after surgical bioprosthetic MVP placement is uncommon and the influence of the MVP strut width has seldom been examined.

Case presentation: A 74-year-old female presented with palpitations, chest pain, and shortness of breath. She had MVR with 31-mm bioprosthetic valve 2 years prior. TEE confirmed LVOT obstruction secondary to a MVP strut, causing a peak gradient of 55 mmHg. The redo operation was complicated by iatrogenic Type A aortic dissection. The patient was immediately cooled for DHCA with RCP and ascending aortic replacement was performed. MVR was then performed with a prosthesis with narrower strut width. Recovery …

Open Transatrial Valve-In-Mitral Annular Calcification Mitral Valve Replacement With An Autologous Anterior Leaflet Sealing Skirt, Omar Saleh, Nicholas Valle, Rishab Agarwal, Israa Saleh, Joshua Dolsen, Connor Mckechnie, Dhruvi Patel, Deepak R. Talreja, Matthew R. Summers, Christopher M. Sciortino

Department of Medicine Faculty Publications

[Central Message] In patients undergoing ViMAC, surgical fixation of the native anterior mitral leaflet to a BEV cuff creates an autologous seal, reducing risk of paravalvular leak and neo-LVOT obstruction.

Failure Rates And Patient-Reported Outcomes Are Similar Across 5 Arthroscopic, Suprapectoral Bicepts Tenodesis Fixation Techniques, Senah E. Stephens, Samantha M. Strohm, Rachael M. Shaughnessy, Katherine S. Worcester, Kevin F. Bonner

Department of Medicine Faculty Publications

Purpose

To compare failure rates and patient‐reported outcome measures (PROMs) across 5 arthroscopic, suprapectoral biceps tenodesis fixation techniques: tenodesis screw, tenodesis anchor, expanding tenodesis anchor, onlay with single all‐suture anchor, and soft tissue tenodesis in the bicipital groove with suture.

Methods

This was a retrospective cohort study approved by the Institutional Review Board, including patients age 18 years or older who underwent arthroscopic, suprapectoral biceps tenodesis between 2014 and 2024 with a minimum of 6 months of clinical follow‐up. Exclusion criteria included cervical pathology, chronic pain syndromes, revisions, and workers' compensation cases. Patients completed PROMs including pain Visual Analog Scale …

Failure Rates And Patient-Reported Outcomes Are Similar Across 5 Arthroscopic, Suprapectoral Biceps Tenodesis Fixation Techniques, Senah E. Stephens, Samantha M. Strohm, Rachael M. Shaughnessy, Katherine S. Worcester, Kevin F. Bonner

Department Surgery Faculty Publications

Purpose

To compare failure rates and patient-reported outcome measures (PROMs) across 5 arthroscopic, suprapectoral biceps tenodesis fixation techniques: tenodesis screw, tenodesis anchor, expanding tenodesis anchor, onlay with single all-suture anchor, and soft tissue tenodesis in the bicipital groove with suture.

Methods

This was a retrospective cohort study approved by the Institutional Review Board, including patients age 18 years or older who underwent arthroscopic, suprapectoral biceps tenodesis between 2014 and 2024 with a minimum of 6 months of clinical follow-up. Exclusion criteria included cervical pathology, chronic pain syndromes, revisions, and workers' compensation cases. Patients completed PROMs including pain Visual Analog Scale …

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 …

Dupilumab For Patients With Allergic Fungal Rhinosinusitis, Amber U. Luong, Joshua M. Levy, Sarah K. Wise, Joseph K. Han, Mamoru Yoshikawa, Luo Zhang, Rodney Schlosser, Prerna Ranganathan, Paula Dakin, Jennifer Maloney, George D. Yancopoulos, Andrew P. Fontenot, Neelam A. Phadke, Lacey R. Robinson

Department of Otolaryngology (ENT) Faculty Publications

Background

Allergic fungal rhinosinusitis (AFRS) is a severe subtype of chronic rhinosinusitis characterized by fungal hypersensitivity and accentuated type 2 inflammation. Dupilumab-a fully human monoclonal antibody blocking interleukin-4/13, approved for type 2 inflammatory diseases, including chronic rhinosinusitis with nasal polyps-may benefit patients with AFRS.

Objective

We sought to understand the effect of dupilumab in AFRS

Methods

In this phase 3 trial, patients with AFRS aged ≥6 years were randomized to dupilumab or matched placebo for 52 weeks. The primary end point was Lund-Mackay computed tomography (LMK-CT) score, quantifying sinus opacification, at 52 weeks. Secondary end points were multiplicity-controlled and hierarchically …