PMID- 30578828 OWN - NLM STAT- MEDLINE DCOM- 20200108 LR - 20201001 IS - 1532-9488 (Electronic) IS - 1043-0679 (Print) IS - 1043-0679 (Linking) VI - 31 IP - 3 DP - 2019 Autumn TI - First Reported Use of Team Cognitive Workload for Root Cause Analysis in Cardiac Surgery. PG - 394-396 LID - S1043-0679(18)30405-2 [pii] LID - 10.1053/j.semtcvs.2018.12.003 [doi] AB - Cognitive workload data of members of the cardiac surgery team can be measured intraoperatively and stored for later analysis. We present a case of a near-miss (medication error) that underwent root cause analysis using workload data. Heart rate variability data, representing workload levels, were collected from the attending surgeon, attending anesthesiologist, and lead perfusionist using wireless heart rate monitors. An episode of cognitive overload of the anesthesiologist due to a distractor was associated with the preventable error. Additional studies are needed to better understand the role of psychophysiological data in enhancing surgical patient safety. CI - Copyright © 2018 Elsevier Inc. All rights reserved. FAU - Zenati, Marco A AU - Zenati MA AD - Divison of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Medical Robotics and Computer-Assisted Surgery (MRCAS) Laboratory, Boston, Massachusetts. Electronic address: Marco_Zenati@hms.harvard.edu. FAU - Leissner, Kay B AU - Leissner KB AD - Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. FAU - Zorca, Suzana AU - Zorca S AD - Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. FAU - Kennedy-Metz, Lauren AU - Kennedy-Metz L AD - Medical Robotics and Computer-Assisted Surgery (MRCAS) Laboratory, Boston, Massachusetts. FAU - Yule, Steven J AU - Yule SJ AD - Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; STRATUS Simulation Center, Brigham & Women's Hospital, Boston, Massachusetts. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Simulation Center, Brigham & Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham & Women's Hospital, Boston, Massachusetts. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20181219 TA - Semin Thorac Cardiovasc Surg JT - Seminars in thoracic and cardiovascular surgery JID - 8917640 RN - 0 (Heparin Antagonists) RN - 0 (Protamines) SB - IM CIN - Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):397-398. PMID: 31100339 MH - Administration, Intravenous MH - Anesthetists/*psychology MH - Clinical Competence MH - *Cognition MH - Coronary Artery Bypass/*adverse effects MH - Heart Rate MH - Heparin Antagonists/administration & dosage/adverse effects MH - Humans MH - Medication Errors/*prevention & control MH - *Near Miss, Healthcare MH - *Patient Care Team MH - Protamines/administration & dosage/adverse effects MH - Risk Assessment MH - Risk Factors MH - Root Cause Analysis MH - *Workload PMC - PMC6584063 MID - NIHMS1517056 OTO - NOTNLM OT - *Cardiac surgery OT - *Cognitive workload OT - *Heart rate variability OT - *Root cause analysis OT - *Team workload EDAT- 2018/12/24 06:00 MHDA- 2020/01/09 06:00 CRDT- 2018/12/23 06:00 PHST- 2018/12/06 00:00 [received] PHST- 2018/12/11 00:00 [accepted] PHST- 2018/12/24 06:00 [pubmed] PHST- 2020/01/09 06:00 [medline] PHST- 2018/12/23 06:00 [entrez] AID - S1043-0679(18)30405-2 [pii] AID - 10.1053/j.semtcvs.2018.12.003 [doi] PST - ppublish SO - Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):394-396. doi: 10.1053/j.semtcvs.2018.12.003. Epub 2018 Dec 19. PMID- 31295623 OWN - NLM STAT- MEDLINE DCOM- 20200929 LR - 20200929 IS - 1532-0480 (Electronic) IS - 1532-0464 (Print) IS - 1532-0464 (Linking) VI - 96 DP - 2019 Aug TI - Physiological synchronization and entropy as measures of team cognitive load. PG - 103250 LID - S1532-0464(19)30169-8 [pii] LID - 10.1016/j.jbi.2019.103250 [doi] AB - The operating room (OR) is a high-risk and complex environment, where multiple specialized professionals work as a team to effectively care for patients in need of surgical interventions. Surgical tasks impose high cognitive demands on OR staff and cognitive overload may have deleterious effects on team performance and patient safety. The aim of the present study was to investigate the feasibility and describe a novel methodological approach to characterize dynamic changes in team cognitive load by measuring synchronization and entropy of heart rate variability parameters during real-life cardiac surgery. Cognitive load was measured by capturing interbeat intervals (IBI) from three team members (surgeon, anesthesiologist and perfusionist) using an unobtrusive wearable heart rate sensor and transmitted in real-time to a smartphone application. Clinical data and operating room audio/video recordings were also collected to provide behavioral and contextual information. We developed symbolic representations of the transient cognitive state of individual team members (Individual Cognitive State - ICS), and overall team (Team Cognitive State - TCS) by comparing IBI data from each team member with themselves and with others. The distribution of TCS symbols during surgery enabled us to display and analyze temporal states and dynamic changes of team cognitive load. Shannon's entropy was calculated to estimate the changing levels of team organization and to detect fluctuations resulting from a variety of cognitive demands and/or specific situations (e.g. medical error, emergency, flow disruptions). An illustrative example from a real cardiac surgery team shows how cognitive load patterns shifted rapidly after an actual near-miss medication event, leading the team to a more organized and synchronized state. The methodological approach described in this study provides a measurement technique for the assessment of team physiological synchronization, which can be applied to many other team-based environments. Future research should gather additional validity evidence to support the proposed methods for team cognitive load measurement. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Center for Medical Simulation, Brigham and Women's Hospital, USA; Department of Emergency Medicine, Harvard Medical School, USA. Electronic address: rdias@bwh.harvard.edu. FAU - Zenati, Marco A AU - Zenati MA AD - Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiothoracic Surgery, Veterans Affairs Boston Healthcare System, USA; Department of Surgery, Harvard Medical School, USA. FAU - Stevens, Ronald AU - Stevens R AD - Brain Research Institute, University of California, Los Angeles School of Medicine, USA. FAU - Gabany, Jennifer M AU - Gabany JM AD - Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiothoracic Surgery, Veterans Affairs Boston Healthcare System, USA. FAU - Yule, Steven J AU - Yule SJ AD - STRATUS Center for Medical Simulation, Brigham and Women's Hospital, USA; Department of Surgery, Harvard Medical School, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20190708 TA - J Biomed Inform JT - Journal of biomedical informatics JID - 100970413 SB - IM MH - *Clinical Competence MH - *Cognition MH - Communication MH - Coronary Artery Bypass MH - Entropy MH - Heart Arrest/surgery MH - Heart-Lung Machine MH - Humans MH - Ischemia/pathology MH - Medical Errors/prevention & control MH - Monitoring, Ambulatory/instrumentation MH - *Operating Rooms MH - *Patient Care Team MH - Pilot Projects MH - *Surgeons MH - *Task Performance and Analysis MH - Tertiary Care Centers MH - Video Recording PMC - PMC7226673 MID - NIHMS1587185 OTO - NOTNLM OT - *Cognitive load OT - *Heart rate variability OT - *Physiological synchronization OT - *Surgery OT - *Teamwork COIS- Declaration of Competing Interest The authors declare that there is no conflict of interest regarding this publication. EDAT- 2019/07/12 06:00 MHDA- 2020/09/30 06:00 CRDT- 2019/07/12 06:00 PHST- 2018/06/05 00:00 [received] PHST- 2019/07/01 00:00 [revised] PHST- 2019/07/07 00:00 [accepted] PHST- 2019/07/12 06:00 [pubmed] PHST- 2020/09/30 06:00 [medline] PHST- 2019/07/12 06:00 [entrez] AID - S1532-0464(19)30169-8 [pii] AID - 10.1016/j.jbi.2019.103250 [doi] PST - ppublish SO - J Biomed Inform. 2019 Aug;96:103250. doi: 10.1016/j.jbi.2019.103250. Epub 2019 Jul 8. PMID- 30740198 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 VI - 2018 DP - 2018 Jun TI - Cognitive Support to Promote Shared Mental Models during Safety-Critical Situations in Cardiac Surgery (Late Breaking Report). PG - 165-167 LID - 10.1109/COGSIMA.2018.8423991 [doi] AB - To address the, currently unmet, need for intra-operative safety-critical cognitive support in cardiac surgery, we have developed, validated, and implemented a series of customized checklists to address intra-operative emergencies, using a simulated operative setting. These crisis checklists are designed to provide cognitive and communication support to the operative team to reduce the likelihood of adverse events and improve adherence to best-practice guidelines. We recruited a number of content specialists including members of the hospital safety network and intraoperative cardiac surgery team members, and utilized a Delphi consensus method to develop procedure-specific guidelines for select intraoperative crises. Cardiac surgery team members were subsequently trained on utilizing the developed checklists, performed operative simulations, and were surveyed to determine checklist facility and effectiveness. We developed and validated five checklists for the following cardiac surgery crisis scenarios: (a) Cardiopulmonary Bypass Failure; (b) Systemic Air Embolism; (c) Venous Air Lock; (d) Protamine Reaction; Heparin Resistance. Upon initiation of the crisis management, a crew resource management approach was triggered. A member of the operative team was designated as the "reader" for each scenario to guide the team through the process. After training, 89% of operative team members surveyed indicated that they would like the crisis checklist to be used if they had one of these events occurring to them. Crisis management challenges members of the cardiac surgery team in reasoning accurately and according to best practice during periods of high cognitive workload and psychological stress. These crisis checklists were developed, validated, and simulated with the goal of supporting human performance and shared mental models in the clinical setting. FAU - Tarola, Christopher L AU - Tarola CL AD - Medical Robotics Assisted Surg. Lab, VABHCS Boston, MA, USA. FAU - Hirji, Sameer AU - Hirji S AD - Department of Surgery BWH, Harvard Medical School Boston, MA, USA. FAU - Yule, Steven J AU - Yule SJ AD - STRATUS Simulation Center BWH, Harvard Medical School Boston, MA, USA. FAU - Gabany, Jennifer M AU - Gabany JM AD - Medical Robotics Assisted Surg. Lab, VABHCS, Harvard Medical School Boston, MA, USA. FAU - Zenati, Alessandro AU - Zenati A AD - Medical Robotics Assisted Surg. Lab, VABHCS, Boston, MA, USA. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Simulation Center BWH, Harvard Medical School Boston, MA, USA. FAU - Zenati, Marco A AU - Zenati MA AD - Medical Robotics Assisted Surg. Lab, VABHCS, Harvard Medical School, Boston, MA,USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20180802 TA - 2018 IEEE Conf Cogn Comput Asp Situat Manag CogSIMA (2018) JT - 2018 IEEE Conference on Cognitive and Computational Aspects of Situation Management (CogSIMA) : proceedings : Boston, MA, USA, 11-14 June 2018. IEEE Conference on Cognitive and Computational Aspects of Situation Management (8th : 2018 :... JID - 101740904 PMC - PMC6364745 MID - NIHMS973512 OTO - NOTNLM OT - cardiac surgery OT - cognitive support OT - patient safety OT - shared mental models EDAT- 2019/02/12 06:00 MHDA- 2019/02/12 06:01 CRDT- 2019/02/12 06:00 PHST- 2019/02/12 06:00 [entrez] PHST- 2019/02/12 06:00 [pubmed] PHST- 2019/02/12 06:01 [medline] AID - 10.1109/COGSIMA.2018.8423991 [doi] PST - ppublish SO - 2018 IEEE Conf Cogn Comput Asp Situat Manag CogSIMA (2018). 2018 Jun;2018:165-167. doi: 10.1109/COGSIMA.2018.8423991. Epub 2018 Aug 2. PMID- 30729236 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 VI - 11041 DP - 2018 Sep TI - A Novel Interoperable Safety System for Improved Coordination and Communication in Cardiac Surgery. PG - 39-45 LID - 10.1007/978-3-030-01201-4_5 [doi] AB - During cardiac surgery there is an unmet need for safe transfer of responsibility for patient oxygenation back and forth from the anesthesia to the perfusion teams. Prior to cardiopulmonary bypass (CPB), lung ventilation is performed by the anesthesia machine ventilator and is the responsibility of the anesthesia team. During CPB, lung ventilation is halted and oxygenation is performed by the CPB oxygenator and perfusion team This recurrent transfer throughout the procedure introduces the rare but serious possibility of a "never event", resulting in the patient's lungs not being ventilated upon stopping the CPB and potentially leading to catastrophic hypoxemia. Monitors and alarms on the anesthesia and bypass machines would not be useful when the other device is operating so they are routinely put into a standby mode until needed. Consequently, in the event that the handoff is missed, there are no alarms to catch the situation. To solve this unmet need, we propose a novel interoperable, context-aware system capable of detecting and acting if this rare situation occurs. Our system is built on the open-source OpenICE framework, allowing it to seamlessly work with a variety of ventilator and bypass machines. FAU - Arney, David AU - Arney D AD - Massachusetts General Hospital, Boston, MA USA. AD - Harvard Medical School, Boston, MA USA. FAU - Rance, Geoffrey AU - Rance G AD - VA Boston Healthcare System. FAU - Rithy, Srey AU - Rithy S AD - VA Boston Healthcare System. FAU - Goldman, Julian M AU - Goldman JM AD - Massachusetts General Hospital, Boston, MA USA. AD - Harvard Medical School, Boston, MA USA. FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School, Boston, MA USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20181002 TA - OR 2.0 Context Aware Oper Theaters Comput Assist Robot Endosc Clin Image Based Proced Skin Image Anal (2018) JT - OR 2.0 context-aware operating theaters, computer assisted robotic endoscopy, clinical image-based procedures, and skin image analysis : first international workshop, OR 2.0 2018, 5th international workshop, CARE 2018, 7th international... JID - 101737036 PMC - PMC6360335 MID - NIHMS990147 OTO - NOTNLM OT - alarms OT - cardiopulmonary bypass OT - interoperability OT - never event EDAT- 2019/02/08 06:00 MHDA- 2019/02/08 06:01 CRDT- 2019/02/08 06:00 PHST- 2019/02/08 06:00 [entrez] PHST- 2019/02/08 06:00 [pubmed] PHST- 2019/02/08 06:01 [medline] AID - 10.1007/978-3-030-01201-4_5 [doi] PST - ppublish SO - OR 2.0 Context Aware Oper Theaters Comput Assist Robot Endosc Clin Image Based Proced Skin Image Anal (2018). 2018 Sep;11041:39-45. doi: 10.1007/978-3-030-01201-4_5. Epub 2018 Oct 2. PMID- 30547096 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 2379-1667 (Print) IS - 2379-1675 (Electronic) IS - 2379-1667 (Linking) VI - 2018 DP - 2018 Jun TI - Development of an Interactive Dashboard to Analyze Cognitive Workload of Surgical Teams During Complex Procedural Care. PG - 77-82 LID - 10.1109/COGSIMA.2018.8423995 [doi] AB - In the surgical setting, team members constantly deal with a high-demand operative environment that requires simultaneously processing a large amount of information. In certain situations, high demands imposed by surgical tasks and other sources may exceed team member's cognitive capacity, leading to cognitive overload which may place patient safety at risk. In the present study, we describe a novel approach to integrate an objective measure of team member's cognitive load with procedural, behavioral and contextual data from real-life cardiac surgeries. We used heart rate variability analysis, capturing data simultaneously from multiple team members (surgeon, anesthesiologist and perfusionist) in a real-time and unobtrusive manner. Using audio-video recordings, behavioral coding and a hierarchical surgical process model, we integrated multiple data sources to create an interactive surgical dashboard, enabling the analysis of the cognitive load imposed by specific steps, substeps and/or tasks. The described approach enables us to detect cognitive load fluctuations over time, under specific conditions (e.g. emergencies, teaching) and in situations that are prone to errors. This in-depth understanding of the relationship between cognitive load, task demands and error occurrence is essential for the development of cognitive support systems to recognize and mitigate errors during complex surgical care in the operating room. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Simulation Center, BWH, Harvard Medical School Boston, MA, USA. FAU - Conboy, Heather M AU - Conboy HM AD - College of Inform. and CS University of Massachusetts, Amherst, USA. FAU - Gabany, Jennifer M AU - Gabany JM AD - Division of Cardiac Surgery, VAHCS, Harvard Medical School, Boston, MA, USA. FAU - Clarke, Lori A AU - Clarke LA AD - College of Inform. and CS, University of Massachusetts, Amherst, USA. FAU - Osterweil, Leon J AU - Osterweil LJ AD - College of Inform. and CS, University of Massachusetts, Amherst, USA. FAU - Avrunin, George S AU - Avrunin GS AD - College of Inform. and CS University of Massachusetts, Amherst, USA. FAU - Arney, David AU - Arney D AD - Department of Anesthesia, MGH, Harvard Medical School Boston, USA. FAU - Goldman, Julian M AU - Goldman JM AD - Department of Anesthesia, MGH, Harvard Medical School, Boston, USA. FAU - Riccardi, Giuseppe AU - Riccardi G AD - Depart. of Inform. Eng. and CS, University of Trento, Trento, Italy. FAU - Yule, Steven J AU - Yule SJ AD - STRATUS Simulation Center, BWH, Harvard Medical School Boston, MA, USA. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, VAHCS, Harvard Medical School, Boston, MA, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20180802 TA - IEEE Int Interdiscip Conf Cogn Methods Situat Aware Decis Support JT - ... IEEE International Inter-Disciplinary Conference on Cognitive Methods in Situation Awareness and Decision Support. IEEE International Multi-Disciplinary Conference on Cognitive Methods in Situation Awareness and Decision Support JID - 101704506 PMC - PMC6289194 MID - NIHMS973713 OTO - NOTNLM OT - *cardiac surgery OT - *cognitive load OT - *heart rate variability OT - *process model EDAT- 2018/12/14 06:00 MHDA- 2018/12/14 06:01 CRDT- 2018/12/15 06:00 PHST- 2018/12/15 06:00 [entrez] PHST- 2018/12/14 06:00 [pubmed] PHST- 2018/12/14 06:01 [medline] AID - 10.1109/COGSIMA.2018.8423995 [doi] PST - ppublish SO - IEEE Int Interdiscip Conf Cogn Methods Situat Aware Decis Support. 2018 Jun;2018:77-82. doi: 10.1109/COGSIMA.2018.8423995. Epub 2018 Aug 2. PMID- 30506066 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 VI - 11041 DP - 2018 Sep TI - Intelligent Interruption Management System to Enhance Safety and Performance in Complex Surgical and Robotic Procedures. PG - 62-68 LID - 10.1007/978-3-030-01201-4_8 [doi] AB - Procedural flow disruptions secondary to interruptions play a key role in error occurrence during complex medical procedures, mainly because they increase mental workload among team members, negatively impacting team performance and patient safety. Since certain types of interruptions are unavoidable, and consequently the need for multitasking is inherent to complex procedural care, this field can benefit from an intelligent system capable of identifying in which moment flow interference is appropriate without generating disruptions. In the present study we describe a novel approach for the identification of tasks imposing low cognitive load and tasks that demand high cognitive effort during real-life cardiac surgeries. We used heart rate variability analysis as an objective measure of cognitive load, capturing data in a real-time and unobtrusive manner from multiple team members (surgeon, anesthesiologist and perfusionist) simultaneously. Using audio-video recordings, behavioral coding and a hierarchical surgical process model, we integrated multiple data sources to create an interactive surgical dashboard, enabling the identification of specific steps, substeps and tasks that impose low cognitive load. An interruption management system can use these low demand situations to guide the surgical team in terms of the appropriateness of flow interruptions. The described approach also enables us to detect cognitive load fluctuations over time, under specific conditions (e.g. emergencies) or in situations that are prone to errors. An in-depth understanding of the relationship between cognitive overload states, task demands, and error occurrence will drive the development of cognitive supporting systems that recognize and mitigate errors efficiently and proactively during high complex procedures. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, MA, USA. AD - Harvard Medical School, Boston, MA, USA. FAU - Conboy, Heather M AU - Conboy HM AD - University of Massachusetts, Amherst, MA, USA. FAU - Gabany, Jennifer M AU - Gabany JM AD - Harvard Medical School, Boston, MA, USA. AD - Division of Cardiac Surgery, VA Healthcare System, Boston, MA, USA. FAU - Clarke, Lori A AU - Clarke LA AD - University of Massachusetts, Amherst, MA, USA. FAU - Osterweil, Leon J AU - Osterweil LJ AD - University of Massachusetts, Amherst, MA, USA. FAU - Arney, David AU - Arney D AD - Harvard Medical School, Boston, MA, USA. AD - Massachusetts General Hospital, Boston, MA, USA. FAU - Goldman, Julian M AU - Goldman JM AD - Harvard Medical School, Boston, MA, USA. AD - Massachusetts General Hospital, Boston, MA, USA. FAU - Riccardi, Giuseppe AU - Riccardi G AD - Department of Information Engineering and Computer Science University of Trento, Italy. FAU - Avrunin, George S AU - Avrunin GS AD - Department of Information Engineering and Computer Science University of Trento, Italy. FAU - Yule, Steven J AU - Yule SJ AD - STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, MA, USA. AD - Harvard Medical School, Boston, MA, USA. AD - Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA. FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School, Boston, MA, USA. AD - Division of Cardiac Surgery, VA Healthcare System, Boston, MA, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20181002 TA - OR 2.0 Context Aware Oper Theaters Comput Assist Robot Endosc Clin Image Based Proced Skin Image Anal (2018) JT - OR 2.0 context-aware operating theaters, computer assisted robotic endoscopy, clinical image-based procedures, and skin image analysis : first international workshop, OR 2.0 2018, 5th international workshop, CARE 2018, 7th international... JID - 101737036 PMC - PMC6267949 MID - NIHMS982560 OTO - NOTNLM OT - cardiac surgery OT - cognitive load OT - heart rate variability OT - process model EDAT- 2018/12/07 06:00 MHDA- 2018/12/07 06:01 CRDT- 2018/12/04 06:00 PHST- 2018/12/04 06:00 [entrez] PHST- 2018/12/07 06:00 [pubmed] PHST- 2018/12/07 06:01 [medline] AID - 10.1007/978-3-030-01201-4_8 [doi] PST - ppublish SO - OR 2.0 Context Aware Oper Theaters Comput Assist Robot Endosc Clin Image Based Proced Skin Image Anal (2018). 2018 Sep;11041:62-68. doi: 10.1007/978-3-030-01201-4_8. Epub 2018 Oct 2. PMID- 28752132 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2379-1667 (Print) IS - 2379-1675 (Electronic) IS - 2379-1667 (Linking) VI - 2017 DP - 2017 Mar TI - Cognitive Support During High-Consequence Episodes of Care in Cardiovascular Surgery. LID - 10.1109/COGSIMA.2017.7929610 [doi] AB - Despite significant efforts to reduce preventable adverse events in medical processes, such events continue to occur at unacceptable rates. This paper describes a computer science approach that uses formal process modeling to provide situationally aware monitoring and management support to medical professionals performing complex processes. These process models represent both normative and non-normative situations, and are validated by rigorous automated techniques such as model checking and fault tree analysis, in addition to careful review by experts. Context-aware Smart Checklists are then generated from the models, providing cognitive support during high-consequence surgical episodes. The approach is illustrated with a case study in cardiovascular surgery. FAU - Conboy, Heather M AU - Conboy HM AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA. FAU - Avrunin, George S AU - Avrunin GS AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA. FAU - Clarke, Lori A AU - Clarke LA AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA. FAU - Osterweil, Leon J AU - Osterweil LJ AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, USA. FAU - Christov, Stefan C AU - Christov SC AD - Department of Engineering, Quinnipiac University, Hamden, CT, USA. FAU - Goldman, Julian M AU - Goldman JM AD - Anesthesiology, MGH, Harvard Medical School, Boston, MA, USA. FAU - Yule, Steven J AU - Yule SJ AD - STRATUS Simulation Center, BWH, and Harvard Medical School, Boston, MA, USA. FAU - Zenati, Marco A AU - Zenati MA AD - BWH, and Division of Cardiac Surgery, VABHCS, Harvard Medical School, Boston, MA, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20170518 TA - IEEE Int Interdiscip Conf Cogn Methods Situat Aware Decis Support JT - ... IEEE International Inter-Disciplinary Conference on Cognitive Methods in Situation Awareness and Decision Support. IEEE International Multi-Disciplinary Conference on Cognitive Methods in Situation Awareness and Decision Support JID - 101704506 PMC - PMC5526347 MID - NIHMS865690 OTO - NOTNLM OT - checklists OT - process modeling OT - situation management EDAT- 2017/07/29 06:00 MHDA- 2017/07/29 06:01 CRDT- 2017/07/29 06:00 PHST- 2017/07/29 06:00 [entrez] PHST- 2017/07/29 06:00 [pubmed] PHST- 2017/07/29 06:01 [medline] AID - 10.1109/COGSIMA.2017.7929610 [doi] PST - ppublish SO - IEEE Int Interdiscip Conf Cogn Methods Situat Aware Decis Support. 2017 Mar;2017:10.1109/COGSIMA.2017.7929610. doi: 10.1109/COGSIMA.2017.7929610. Epub 2017 May 18. PMID- 30140792 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 VI - 2018 DP - 2018 May TI - Toward Improving Surgical Outcomes by Incorporating Cognitive Load Measurement into Process-Driven Guidance. PG - 2-9 LID - 10.1145/3194696.3194705 [doi] AB - This paper summarizes the accomplishments and recent directions of our medical safety project. Our process-based approach uses a detailed, rigorously-defined, and carefully validated process model to provide a dynamically updated, context-aware and thus, "Smart" Checklist to help process performers understand and manage their pending tasks [7]. This paper focuses on support for teams of performers, working independently as well as in close collaboration, in stressful situations that are life critical. Our recent work has three main thrusts: provide effective real-time guidance for closely collaborating teams; develop and evaluate techniques for measuring cognitive load based on biometric observations and human surveys; and, using these measurements plus analysis and discrete event process simulation, predict cognitive load throughout the process model and propose process modifications to help performers better manage high cognitive load situations. This project is a collaboration among software engineers, surgical team members, human factors researchers, and medical equipment instrumentation experts. Experimental prototype capabilities are being built and evaluated based upon process models of two cardiovascular surgery processes, Aortic Valve Replacement (AVR) and Coronary Artery Bypass Grafting (CABG). In this paper we describe our approach for each of the three research thrusts by illustrating our work for heparinization, a common subprocess of both AVR and CABG. Heparinization is a high-risk error-prone procedure that involves complex team interactions and thus highlights the importance of this work for improving patient outcomes. FAU - Avrunin, George S AU - Avrunin GS AD - University of Massachusetts Amherst, Massachusetts, USA. FAU - Clarke, Lori A AU - Clarke LA AD - University of Massachusetts Amherst, Massachusetts, USA. FAU - Conboy, Heather M AU - Conboy HM AD - University of Massachusetts Amherst, Massachusetts, USA. FAU - Osterweil, Leon J AU - Osterweil LJ AD - University of Massachusetts Amherst, Massachusetts, USA. FAU - Dias, Roger D AU - Dias RD AD - Brigham and Women's Hospital Boston, Massachusetts, USA. FAU - Yule, Steven J AU - Yule SJ AD - Harvard Medical School Boston, Massachusetts, USA. FAU - Goldman, Julian M AU - Goldman JM AD - Massachusetts General Hospital Cambridge, Massachusetts, USA. FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School Boston, Massachusetts, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Softw Eng Healthc Syst SEHS IEEE ACM Int Workshop JT - Software Engineering in Healthcare Systems (SEHS), IEEE/ACM International Workshop on JID - 101732377 PMC - PMC6103223 MID - NIHMS973513 OTO - NOTNLM OT - Process modeling OT - augmented cognition OT - checklists OT - cognitive load OT - simulation OT - surgical data science OT - surgical patient safety EDAT- 2018/08/25 06:00 MHDA- 2018/08/25 06:01 CRDT- 2018/08/25 06:00 PHST- 2018/08/25 06:00 [entrez] PHST- 2018/08/25 06:00 [pubmed] PHST- 2018/08/25 06:01 [medline] AID - 10.1145/3194696.3194705 [doi] PST - ppublish SO - Softw Eng Healthc Syst SEHS IEEE ACM Int Workshop. 2018 May;2018:2-9. doi: 10.1145/3194696.3194705. PMID- 24673955 OWN - NLM STAT- MEDLINE DCOM- 20141124 LR - 20151119 IS - 1532-9488 (Electronic) IS - 1043-0679 (Linking) VI - 25 IP - 4 DP - 2013 Winter TI - Conduits in coronary artery bypass grafting. PG - 273-9 LID - S1043-0679(14)00003-3 [pii] LID - 10.1053/j.semtcvs.2014.01.002 [doi] AB - Modern cardiac practice in the United States is conservative when it comes to using bilateral internal mammary or radial artery grafts in coronary artery bypass surgery. Here, we examine the evidence regarding using other arterial grafts instead of veins as a complement to left internal mammary artery in surgical revascularization. In addition, we put our report in perspective relative to prevailing practice, professional societal guidelines, and future directions in coronary artery bypass grafting. CI - Published by Elsevier Inc. FAU - Bakaeen, Faisal G AU - Bakaeen FG AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas. Electronic address: fbakaeen@bcm.edu. FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Cardiothoracic Surgery, VA Boston Healthcare System, Boston, Massachusetts. FAU - Bhatt, Deepak L AU - Bhatt DL AD - Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts. LA - eng PT - Journal Article DEP - 20140128 PL - United States TA - Semin Thorac Cardiovasc Surg JT - Seminars in thoracic and cardiovascular surgery JID - 8917640 SB - IM MH - Coronary Artery Bypass/adverse effects/*methods/standards MH - Gastroepiploic Artery/transplantation MH - Humans MH - *Internal Mammary-Coronary Artery Anastomosis/adverse effects/standards MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians' MH - Radial Artery/*transplantation MH - Saphenous Vein/transplantation MH - Treatment Outcome OTO - NOTNLM OT - arterial conduits OT - coronary artery bypass grafting OT - internal mammary artery OT - radial artery OT - saphenous vein graft EDAT- 2013/01/01 00:00 MHDA- 2014/12/15 06:00 CRDT- 2014/03/29 06:00 PHST- 2014/01/06 00:00 [accepted] PHST- 2014/03/29 06:00 [entrez] PHST- 2013/01/01 00:00 [pubmed] PHST- 2014/12/15 06:00 [medline] AID - S1043-0679(14)00003-3 [pii] AID - 10.1053/j.semtcvs.2014.01.002 [doi] PST - ppublish SO - Semin Thorac Cardiovasc Surg. 2013 Winter;25(4):273-9. doi: 10.1053/j.semtcvs.2014.01.002. Epub 2014 Jan 28. PMID- 21130476 OWN - NLM STAT- MEDLINE DCOM- 20110217 LR - 20161125 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 141 IP - 2 DP - 2011 Feb TI - Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. PG - 338-44 LID - 10.1016/j.jtcvs.2010.10.004 [doi] AB - OBJECTIVE: In the Randomized On/Off Bypass (ROOBY) Trial, the efficacy of on-pump versus off-pump coronary artery bypass grafting was evaluated. This ROOBY Trial planned subanalysis compared the effects on postbypass patient clinical outcomes and graft patency of endoscopic vein harvesting and open vein harvesting. METHODS: From April 2003 to April 2007, the technique used for saphenous vein graft harvesting was recorded in 1471 cases. Of these, 894 patients (341 endoscopic harvest and 553 open harvest) also underwent coronary angiography 1 year after coronary artery bypass grafting. Univariate and multivariable analyses were used to compare patient outcomes in the endoscopic and open groups. RESULTS: Preoperative patient characteristics were statistically similar between the endoscopic and open groups. Endoscopic vein harvest was used in 38% of the cases. There were no significant differences in both short-term and 1-year composite outcomes between the endoscopic and open groups. For patients with 1-year catheterization follow-up (n=894), the saphenous vein graft patency rate for the endoscopic group was lower than that in the open harvest group (74.5% vs 85.2%, P<.0001), and the repeat revascularization rate was significantly higher (6.7% vs 3.4%, P<.05). Multivariable regression documented no interaction effect between endoscopic approach and off-pump treatment. CONCLUSIONS: In the ROOBY Trial, endoscopic vein harvest was associated with lower 1-year saphenous vein graft patency and higher 1-year revascularization rates, independent of the use of off-pump or on-pump cardiac surgical approach. CI - Published by Mosby, Inc. FAU - Zenati, Marco A AU - Zenati MA AD - Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA. Marco_Zenati@hms.harvard.edu FAU - Shroyer, A Laurie AU - Shroyer AL FAU - Collins, Joseph F AU - Collins JF FAU - Hattler, Brack AU - Hattler B FAU - Ota, Takeyoshi AU - Ota T FAU - Almassi, G Hossein AU - Almassi GH FAU - Amidi, Morteza AU - Amidi M FAU - Novitzky, Dimitri AU - Novitzky D FAU - Grover, Frederick L AU - Grover FL FAU - Sonel, Ali F AU - Sonel AF LA - eng SI - ClinicalTrials.gov/NCT00032630 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20101203 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CIN - J Thorac Cardiovasc Surg. 2011 Aug;142(2):481; author reply 481-2. PMID: 21763888 CIN - J Thorac Cardiovasc Surg. 2011 Sep;142(3):724-5; author reply 725. PMID: 21843770 MH - Aged MH - Chi-Square Distribution MH - Coronary Angiography MH - *Coronary Artery Bypass/adverse effects/mortality MH - *Coronary Artery Bypass, Off-Pump/adverse effects/mortality MH - Coronary Artery Disease/diagnostic imaging/mortality/*surgery MH - *Endoscopy/adverse effects/mortality MH - Female MH - Graft Occlusion, Vascular/diagnostic imaging/etiology MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Risk Assessment MH - Risk Factors MH - Saphenous Vein/diagnostic imaging/*transplantation MH - Single-Blind Method MH - Time Factors MH - Tissue and Organ Harvesting/adverse effects/*methods/mortality MH - Treatment Outcome MH - United States MH - Vascular Patency EDAT- 2010/12/07 06:00 MHDA- 2011/02/18 06:00 CRDT- 2010/12/07 06:00 PHST- 2010/04/30 00:00 [received] PHST- 2010/09/27 00:00 [revised] PHST- 2010/10/01 00:00 [accepted] PHST- 2010/12/07 06:00 [entrez] PHST- 2010/12/07 06:00 [pubmed] PHST- 2011/02/18 06:00 [medline] AID - S0022-5223(10)01164-5 [pii] AID - 10.1016/j.jtcvs.2010.10.004 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2011 Feb;141(2):338-44. doi: 10.1016/j.jtcvs.2010.10.004. Epub 2010 Dec 3. PMID- 30936587 OWN - NLM STAT- MEDLINE DCOM- 20190426 LR - 20200225 IS - 0022-1058 (Print) IS - 0022-1058 (Linking) VI - 51 IP - 1 DP - 2019 Mar TI - Establishing a Ventilator-Heart Lung Machine Communication Bridge to Mitigate Errors when Weaning from Bypass. PG - 38-40 AB - If a perfusionist weans a patient off the heart lung machine (HLM) and the anesthesiologist has not re-started the ventilator, the patient will become hypoxic. The objective of this project was to create a redundant safety system of verbal and electronic communication to prevent failure to ventilate errors after cardiopulmonary bypass. This objective could be realized by building an electronic communication bridge directly between the HLM and ventilator. A software application was created to retrieve and interpret data from the pump and ventilator and trigger a programmed smart alarm. The software is able to interpret data from the pump and ventilator. When both are off simultaneously (defined as a pump flow of 0 L/min with a respiratory rate of 0 breaths/min), the application will raies an alarm. Communication between a pump and ventilator is possible, enabling the deployment of a safety system that could exist in the operating room (OR) as a standalone alarm. A device dataset can be used to optimize clinical performance of the alarm. The application could also be integrated into smart checklists and computer-assisted OR process models that are currently in development. FAU - Rance, Geoffrey AU - Rance G AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. FAU - Arney, David AU - Arney D AD - Massachusetts General Hospital, Boston, Massachusetts; and. AD - Harvard Medical School, Boston, Massachusetts. FAU - Srey, Rithy AU - Srey R AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. FAU - Goldman, Julian M AU - Goldman JM AD - Massachusetts General Hospital, Boston, Massachusetts; and. AD - Harvard Medical School, Boston, Massachusetts. FAU - Zenati, Marco A AU - Zenati MA AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. AD - Harvard Medical School, Boston, Massachusetts. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article TA - J Extra Corpor Technol JT - The journal of extra-corporeal technology JID - 0267637 MH - *Cardiopulmonary Bypass MH - Humans MH - Vascular Surgical Procedures MH - *Ventilators, Mechanical PMC - PMC6436169 OTO - NOTNLM OT - cardiopulmonary bypass OT - patient safety OT - perfusion OT - ventilation EDAT- 2019/04/03 06:00 MHDA- 2019/04/27 06:00 CRDT- 2019/04/03 06:00 PHST- 2018/09/19 00:00 [received] PHST- 2019/01/25 00:00 [accepted] PHST- 2019/04/03 06:00 [entrez] PHST- 2019/04/03 06:00 [pubmed] PHST- 2019/04/27 06:00 [medline] AID - 1800045 [pii] PST - ppublish SO - J Extra Corpor Technol. 2019 Mar;51(1):38-40. PMID- 30119285 OWN - NLM STAT- MEDLINE DCOM- 20190918 LR - 20190918 IS - 1097-685X (Electronic) IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 156 IP - 3 DP - 2018 Sep TI - Cutting off the lizard's tail in surgery. PG - 1220-1221 LID - S0022-5223(18)30586-5 [pii] LID - 10.1016/j.jtcvs.2018.02.047 [doi] FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School, Harvard University, Boston, Mass; Division of Cardiothoracic Surgery, Veterans Affairs Boston Healthcare System, Boston, Mass. FAU - Scarinci, Andrea AU - Scarinci A AD - Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, Mass. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Comment PT - Letter PT - Research Support, N.I.H., Extramural TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CON - J Thorac Cardiovasc Surg. 2018 Feb;155(2):690-696.e1. PMID: 29415390 CIN - J Thorac Cardiovasc Surg. 2018 Sep;156(3):1221. PMID: 30119286 MH - Animals MH - *Lizards PMC - PMC6100786 MID - NIHMS962180 EDAT- 2018/08/19 06:00 MHDA- 2019/09/19 06:00 CRDT- 2018/08/19 06:00 PHST- 2018/02/11 00:00 [received] PHST- 2018/02/14 00:00 [accepted] PHST- 2018/08/19 06:00 [entrez] PHST- 2018/08/19 06:00 [pubmed] PHST- 2019/09/19 06:00 [medline] AID - S0022-5223(18)30586-5 [pii] AID - 10.1016/j.jtcvs.2018.02.047 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2018 Sep;156(3):1220-1221. doi: 10.1016/j.jtcvs.2018.02.047. PMID- 27706489 OWN - NLM STAT- MEDLINE DCOM- 20180326 LR - 20191210 IS - 2168-6262 (Electronic) IS - 2168-6254 (Print) IS - 2168-6254 (Linking) VI - 151 IP - 12 DP - 2016 Dec 1 TI - Computer-Assisted Process Modeling to Enhance Intraoperative Safety in Cardiac Surgery. PG - 1183-1186 LID - 10.1001/jamasurg.2016.2839 [doi] FAU - Tarola, Christopher L AU - Tarola CL AD - Harvard School of Public Health, Boston, Massachusetts3Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. FAU - Quin, Jacquelyn A AU - Quin JA AD - Harvard Medical School, Boston, Massachusetts3Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. FAU - Haime, Miguel E AU - Haime ME AD - Harvard Medical School, Boston, Massachusetts3Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. FAU - Gabany, Jennifer M AU - Gabany JM AD - Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. FAU - Taylor, Kristin B AU - Taylor KB AD - Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. FAU - Leissner, Kay B AU - Leissner KB AD - Harvard Medical School, Boston, Massachusetts3Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School, Boston, Massachusetts3Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article TA - JAMA Surg JT - JAMA surgery JID - 101589553 SB - IM MH - Algorithms MH - Cardiac Surgical Procedures/*methods MH - Feasibility Studies MH - Guideline Adherence MH - Humans MH - Intraoperative Period MH - Medical Errors/*prevention & control MH - Patient Care Team MH - *Patient Safety MH - Pilot Projects MH - *Process Assessment, Health Care MH - Prospective Studies MH - Speech Recognition Software MH - Surgery, Computer-Assisted/*methods MH - *Workflow PMC - PMC5177530 MID - NIHMS822518 EDAT- 2016/10/06 06:00 MHDA- 2018/03/27 06:00 CRDT- 2016/10/06 06:00 PHST- 2016/10/06 06:00 [pubmed] PHST- 2018/03/27 06:00 [medline] PHST- 2016/10/06 06:00 [entrez] AID - 2559964 [pii] AID - 10.1001/jamasurg.2016.2839 [doi] PST - ppublish SO - JAMA Surg. 2016 Dec 1;151(12):1183-1186. doi: 10.1001/jamasurg.2016.2839. PMID- 29778338 OWN - NLM STAT- MEDLINE DCOM- 20190918 LR - 20190918 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 156 IP - 4 DP - 2018 Oct TI - Real-world revascularization therapy in heart failure: It's a jungle out there! PG - 1422-1423 LID - S0022-5223(18)31207-8 [pii] LID - 10.1016/j.jtcvs.2018.04.070 [doi] FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiothoracic Surgery, Veterans Affairs Boston Healthcare System, Boston, Mass; Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: Marco_Zenati@hms.harvard.edu. FAU - Bhatt, Deepak L AU - Bhatt DL AD - Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Mass. LA - eng PT - Comment PT - Editorial DEP - 20180424 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CON - J Thorac Cardiovasc Surg. 2018 Oct;156(4):1410-1421.e2. PMID: 29961592 MH - Coronary Artery Bypass MH - *Heart Failure MH - Humans MH - *Percutaneous Coronary Intervention EDAT- 2018/05/21 06:00 MHDA- 2019/09/19 06:00 CRDT- 2018/05/21 06:00 PHST- 2018/04/16 00:00 [received] PHST- 2018/04/16 00:00 [accepted] PHST- 2018/05/21 06:00 [pubmed] PHST- 2019/09/19 06:00 [medline] PHST- 2018/05/21 06:00 [entrez] AID - S0022-5223(18)31207-8 [pii] AID - 10.1016/j.jtcvs.2018.04.070 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2018 Oct;156(4):1422-1423. doi: 10.1016/j.jtcvs.2018.04.070. Epub 2018 Apr 24. PMID- 29465749 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20210503 IS - 1365-2168 (Electronic) IS - 0007-1323 (Print) IS - 0007-1323 (Linking) VI - 105 IP - 5 DP - 2018 Apr TI - Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload. PG - 491-501 LID - 10.1002/bjs.10795 [doi] AB - BACKGROUND: Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics. METHODS: A search strategy encompassing MEDLINE, Embase, Web of Science, PsycINFO, ACM Digital Library, IEEE Xplore, PROSPERO and the Cochrane database was developed to identify peer-reviewed articles published from inception to November 2016. Quality was assessed by using the Medical Education Research Study Quality Instrument (MERSQI). A summary table was created to describe study design, setting, specialty, participants, cognitive load measures and MERSQI score. RESULTS: Of 391 articles retrieved, 84 met the inclusion criteria, totalling 2053 unique participants. Most studies were carried out in a simulated setting (59 studies, 70 per cent). Sixty studies (71 per cent) used self-reporting methods, of which the NASA Task Load Index (NASA-TLX) was the most commonly applied tool (44 studies, 52 per cent). Heart rate variability analysis was the most used real-time method (11 studies, 13 per cent). CONCLUSION: Self-report instruments are valuable when the aim is to assess the overall cognitive load in different surgical procedures and assess learning curves within competence-based surgical education. When the aim is to assess cognitive load related to specific operative stages, real-time tools should be used, as they allow capture of cognitive load fluctuation. A combination of both subjective and objective methods might provide optimal measurement of surgeons' cognition. CI - © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd. FAU - Dias, R D AU - Dias RD AUID- ORCID: 0000-0003-4959-5052 AD - STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. FAU - Ngo-Howard, M C AU - Ngo-Howard MC AD - Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA. AD - Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA. FAU - Boskovski, M T AU - Boskovski MT AD - Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. FAU - Zenati, M A AU - Zenati MA AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA. FAU - Yule, S J AU - Yule SJ AD - STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States GR - T32 HL007572/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Systematic Review DEP - 20180221 TA - Br J Surg JT - The British journal of surgery JID - 0372553 SB - IM MH - *Clinical Competence MH - Cognition/*physiology MH - Humans MH - *Self Report MH - Surgeons/*psychology MH - Workload/*psychology PMC - PMC5878696 MID - NIHMS921855 EDAT- 2018/02/22 06:00 MHDA- 2018/12/12 06:00 CRDT- 2018/02/22 06:00 PHST- 2017/08/21 00:00 [received] PHST- 2017/10/09 00:00 [revised] PHST- 2017/11/17 00:00 [accepted] PHST- 2018/02/22 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] PHST- 2018/02/22 06:00 [entrez] AID - bjs.10795 [pii] AID - 10.1002/bjs.10795 [doi] PST - ppublish SO - Br J Surg. 2018 Apr;105(5):491-501. doi: 10.1002/bjs.10795. Epub 2018 Feb 21. PMID- 10534811 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 118 IP - 5 DP - 1999 Nov TI - Emerging new concepts of myocardial laser revascularization. PG - 977-8 FAU - Zenati, M AU - Zenati M AD - Director, Minimally Invasive Cardiac Surgery Program. FAU - Cohen, HA AU - Cohen HA LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 EDAT- 1999/10/27 00:00 MHDA- 1999/10/27 00:01 CRDT- 1999/10/27 00:00 PHST- 1999/10/27 00:00 [pubmed] PHST- 1999/10/27 00:01 [medline] PHST- 1999/10/27 00:00 [entrez] AID - a101410 [pii] AID - 10.1016/s0022-5223(99)70082-6 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 1999 Nov;118(5):977-8. doi: 10.1016/s0022-5223(99)70082-6. PMID- 2507825 OWN - NLM STAT- MEDLINE DCOM- 19891031 LR - 20191210 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 98 IP - 4 DP - 1989 Oct TI - Infections in mortally ill cardiac transplant recipients. PG - 506-9 AB - A total of 351 cardiac transplantations performed between June 1, 1980, and Sept. 30, 1987, were reviewed to determine if infectious complications were more frequent in those patients requiring preoperative intravenous inotropic support, placement of an intraaortic balloon pump, or mechanical support with a left ventricular assist device or total artificial heart. One hundred forty-nine transplants (45%) were performed in these mortally ill patients. There was no statistically significant difference between patients with and without infection within each support group for the following: the number of in-patient days awaiting a donor heart, the number of days receiving support, the percent of patients with preoperative tracheal intubation, the length of the operation, and the percent of patients requiring reoperation for bleeding. The need for invasive methods of support (intraaortic balloon pump, left ventricular assist device, or total artificial heart) in patients awaiting heart transplantation increases the prevalence of perioperative nonviral infection. Preoperative mechanical support with a left ventricular assist device or total artificial heart significantly increases the risk of infection-related mortality. FAU - Hsu, J AU - Hsu J AD - Department of Surgery, University of Pittsburgh, PA 15261. FAU - Griffith, B P AU - Griffith BP FAU - Dowling, R D AU - Dowling RD FAU - Kormos, R L AU - Kormos RL FAU - Dummer, J S AU - Dummer JS FAU - Armitage, J M AU - Armitage JM FAU - Zenati, M AU - Zenati M FAU - Hardesty, R L AU - Hardesty RL LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 RN - 0 (Cardiotonic Agents) SB - IM MH - Adult MH - Cardiotonic Agents/therapeutic use MH - Heart Diseases/complications/physiopathology/therapy MH - *Heart Transplantation MH - Heart, Artificial MH - Humans MH - Infection Control MH - *Infections/complications/diagnosis MH - Intra-Aortic Balloon Pumping MH - Retrospective Studies EDAT- 1989/10/01 00:00 MHDA- 1989/10/01 00:01 CRDT- 1989/10/01 00:00 PHST- 1989/10/01 00:00 [pubmed] PHST- 1989/10/01 00:01 [medline] PHST- 1989/10/01 00:00 [entrez] PST - ppublish SO - J Thorac Cardiovasc Surg. 1989 Oct;98(4):506-9. PMID- 29074046 OWN - NLM STAT- MEDLINE DCOM- 20190918 LR - 20191210 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 155 IP - 1 DP - 2018 Jan TI - Mitral valve surgery in the US Veterans Administration health system: 10-year outcomes and trends. PG - 105-117.e5 LID - S0022-5223(17)32144-X [pii] LID - 10.1016/j.jtcvs.2017.07.089 [doi] AB - OBJECTIVE: To compare mitral valve repair (MVRepair) and mitral valve replacement (MVReplace) trends in the Veterans Affairs (VA) Surgical Quality Improvement Program. METHODS: Trends were compared by bivariate analyses, followed by backward stepwise selection and multivariable logistic modeling to determine the effect of preoperative comorbidities and facility-level factors on MVRepair (vs MVReplace) rate. A subgroup analysis focused on patients who underwent elective surgery for isolated primary degenerative mitral regurgitation. Propensity matching was done in the overall and primary degenerative cohorts. RESULTS: From October 2000 to October 2013, 4165 veterans underwent MVRepair (n = 2408) or MVReplace (n = 1757) for MV disease of any cause at 40 VA medical centers (procedural volume, 0-29/y; median 7/y). The MVRepair percentage increased from 48% in 2001 to 63% in 2013 (P < .001). MVRepair rates varied widely among centers; center volume explained only 19% of this variation after adjustment for case mix (R(2) = 0.19, P = .005). Unadjusted 30-day and 1-year mortality rates were lower after MVRepair than after MVReplace (3.5% vs 4.8%, P = .04; 9.8% vs 12.1%, P = .02). Among the propensity-matched patients (n = 2520), 30-day and 1-year mortality were similar after MVRepair and MVReplace. In the propensity-matched primary degenerative subgroup (n = 664), unadjusted long-term mortality for up to 10 years postoperatively was lower after MVRepair (28% vs 37%, P = .003), as was risk-adjusted long-term mortality (hazard ratio, 0.78; 95% confidence interval, 0.61-1.01). CONCLUSIONS: In the VA Health System, mortality after MV operations is low. Despite the survival advantage associated with MV repair in primary mitral regurgitation, repair is infrequent at some centers, representing an opportunity for quality improvement. CI - Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved. FAU - Bakaeen, Faisal G AU - Bakaeen FG AD - Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: Bakaeef@ccf.org. FAU - Shroyer, A Laurie AU - Shroyer AL AD - Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Research and Development Office, Northport VA Medical Center, Northport, NY. FAU - Zenati, Marco A AU - Zenati MA AD - Department of Surgery, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. FAU - Badhwar, Vinay AU - Badhwar V AD - Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WVa. FAU - Thourani, Vinod H AU - Thourani VH AD - Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga. FAU - Gammie, James S AU - Gammie JS AD - Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md. FAU - Suri, Rakesh M AU - Suri RM AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Sabik, Joseph F 3rd AU - Sabik JF 3rd AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Gillinov, A Marc AU - Gillinov AM AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Chu, Danny AU - Chu D AD - Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa. FAU - Omer, Shuab AU - Omer S AD - Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex. FAU - Hawn, Mary T AU - Hawn MT AD - Department of Surgery, Stanford University, Palo Alto, Calif. FAU - Almassi, G Hossein AU - Almassi GH AD - Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis; Zablocki VA Medical Center, Milwaukee, Wis. FAU - Cornwell, Lorraine D AU - Cornwell LD AD - Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex. FAU - Grover, Frederick L AU - Grover FL AD - Department of Surgery, University of Colorado Denver, Aurora, Colo; Denver VA Medical Center, Aurora, Colo. FAU - Rosengart, Todd K AU - Rosengart TK AD - Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex. FAU - Graham, Laura AU - Graham L AD - The Birmingham and Tuscaloosa Health Services Research & Development Program, Birmingham VA Medical Center, Birmingham, Ala; Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala. LA - eng PT - Comparative Study PT - Journal Article DEP - 20170930 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CIN - J Thorac Cardiovasc Surg. 2018 Jan;155(1):80-81. PMID: 28964493 CIN - J Thorac Cardiovasc Surg. 2018 Jan;155(1):115-117. PMID: 29074045 CIN - J Thorac Cardiovasc Surg. 2018 Jan;155(1):118-119. PMID: 29100580 MH - Aged MH - Comorbidity MH - Female MH - *Heart Valve Prosthesis Implantation/adverse effects/methods/trends MH - Humans MH - Male MH - Middle Aged MH - *Mitral Valve/pathology/surgery MH - *Mitral Valve Annuloplasty/adverse effects/methods/statistics & numerical data/trends MH - *Mitral Valve Insufficiency/diagnosis/epidemiology/surgery MH - Mortality MH - Outcome and Process Assessment, Health Care MH - Postoperative Complications/*mortality MH - Quality Improvement MH - Risk Factors MH - United States/epidemiology MH - United States Department of Veterans Affairs/statistics & numerical data MH - Veterans MH - *Veterans Health/standards/statistics & numerical data OTO - NOTNLM OT - *mitral valve OT - *mitral valve repair OT - *mitral valve replacement OT - *outcomes OT - *trends OT - *volume EDAT- 2017/10/28 06:00 MHDA- 2019/09/19 06:00 CRDT- 2017/10/28 06:00 PHST- 2016/05/20 00:00 [received] PHST- 2017/07/11 00:00 [revised] PHST- 2017/07/28 00:00 [accepted] PHST- 2017/10/28 06:00 [pubmed] PHST- 2019/09/19 06:00 [medline] PHST- 2017/10/28 06:00 [entrez] AID - S0022-5223(17)32144-X [pii] AID - 10.1016/j.jtcvs.2017.07.089 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2018 Jan;155(1):105-117.e5. doi: 10.1016/j.jtcvs.2017.07.089. Epub 2017 Sep 30. PMID- 22054659 OWN - NLM STAT- MEDLINE DCOM- 20120201 LR - 20210330 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 143 IP - 1 DP - 2012 Jan TI - Predictors and impact of postoperative atrial fibrillation on patients' outcomes: a report from the Randomized On Versus Off Bypass trial. PG - 93-102 LID - 10.1016/j.jtcvs.2011.10.003 [doi] AB - OBJECTIVE: The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) in patients randomized to conventional coronary artery bypass graft (on-pump coronary artery bypass [ONCAB]) versus beating heart coronary surgery (off-pump coronary artery bypass [OPCAB]). METHODS: The subgroup of 2103 patients (of 2203 enrollees) in the Randomized On Versus Off Bypass trial with no POAF was studied (1056 patients in the ONCAB group and 1047 patients in the OPCAB group). Univariate and multivariate analyses were used to identify the predictors of POAF and the impact of POAF on outcomes. RESULTS: Use of ONCAB versus OPCAB was not associated with increased rates of POAF. Older age (P < .0001), white race (P < .001), and hypertension (P < .002) were predictors of POAF on multivariate analysis. In general, POAF led to a higher rates of reintubation (ONCAB: 6.3% vs 0.8% no POAF, P < .001; OPCAB: 7.4% vs 1.8% no POAF, P < .0001) and prolonged ventilatory support (ONCAB: 7.1% vs 2.3% no POAF, P = .001; OPCAB: 9.2% vs 3.4% no POAF, P = .0003). The rate of any early adverse outcome was higher in patients with POAF (all patients: 10% POAF vs 4.7% no POAF, P < .0001; ONCAB: 9% POAF vs 4.3% no POAF, P = .008; OPCAB: 11% POAF vs 5.1% no POAF, P = .001). The 1-year all cause mortality was higher with POAF for both groups (ONCAB: 5.4% POAF vs 2% no POAF, P = .009; OPCAB: 5.1% POAF vs 2.6% no POAF, P = .07). POAF was independently associated with early composite end point (odds ratio [OR], 2.23; confidence interval [CI], 1.55-3.22; P < .0001), need for new mechanical support (OR, 3.25; CI, 1.39-7.61; P = .007), prolonged ventilatory support (OR, 2.93; CI, 1.89-4.55; P < .0001), renal failure (OR, 5.42; CI, 1.94-15.15; P = .001), and mortality at 12 months (OR, 1.94; CI, 1.14-3.28; P = .01). CONCLUSIONS: In the Randomized On Versus Off Bypass trial, the strategy of revascularization did not affect the rate of POAF. Age, race, and hypertension were predictors of POAF. POAF was independently associated with a higher short-term morbidity and higher 1-year mortality rates. CI - Published by Mosby, Inc. FAU - Almassi, G Hossein AU - Almassi GH AD - Division of Cardiothoracic Surgery, Clement J. Zablocki Veterans Affairs Medical Center, and Medical College of Wisconsin, Milwaukee, Wis 53226, USA. halmassi@mcw.edu FAU - Pecsi, Sharon A AU - Pecsi SA FAU - Collins, Joseph F AU - Collins JF FAU - Shroyer, A Laurie AU - Shroyer AL FAU - Zenati, Marco A AU - Zenati MA FAU - Grover, Frederick L AU - Grover FL LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20111104 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM EIN - J Thorac Cardiovasc Surg. 2021 Jun;161(6):2202. PMID: 33781596 MH - Aged MH - Atrial Fibrillation/*epidemiology/*etiology MH - Coronary Artery Bypass/*adverse effects MH - Coronary Artery Bypass, Off-Pump MH - Female MH - Humans MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - Single-Blind Method MH - Survival Rate MH - Treatment Outcome EDAT- 2011/11/08 06:00 MHDA- 2012/02/02 06:00 CRDT- 2011/11/08 06:00 PHST- 2011/04/04 00:00 [received] PHST- 2011/09/10 00:00 [revised] PHST- 2011/10/03 00:00 [accepted] PHST- 2011/11/08 06:00 [entrez] PHST- 2011/11/08 06:00 [pubmed] PHST- 2012/02/02 06:00 [medline] AID - S0022-5223(11)01086-5 [pii] AID - 10.1016/j.jtcvs.2011.10.003 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2012 Jan;143(1):93-102. doi: 10.1016/j.jtcvs.2011.10.003. Epub 2011 Nov 4. PMID- 19818457 OWN - NLM STAT- MEDLINE DCOM- 20100616 LR - 20100524 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 139 IP - 6 DP - 2010 Jun TI - Subxiphoid epicardial left ventricular pacing lead placement is feasible. PG - 1661-2 LID - 10.1016/j.jtcvs.2009.06.031 [doi] FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA. FAU - Schwartzman, David AU - Schwartzman D FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Case Reports PT - Journal Article DEP - 20091008 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM MH - Aged MH - Female MH - Heart Ventricles MH - Humans MH - *Pacemaker, Artificial MH - Pericardium MH - Prosthesis Implantation/methods MH - Xiphoid Bone EDAT- 2009/10/13 06:00 MHDA- 2010/06/17 06:00 CRDT- 2009/10/13 06:00 PHST- 2009/05/24 00:00 [received] PHST- 2009/06/10 00:00 [revised] PHST- 2009/06/10 00:00 [accepted] PHST- 2009/10/13 06:00 [entrez] PHST- 2009/10/13 06:00 [pubmed] PHST- 2010/06/17 06:00 [medline] AID - S0022-5223(09)01049-6 [pii] AID - 10.1016/j.jtcvs.2009.06.031 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2010 Jun;139(6):1661-2. doi: 10.1016/j.jtcvs.2009.06.031. Epub 2009 Oct 8. PMID- 19324161 OWN - NLM STAT- MEDLINE DCOM- 20090413 LR - 20211020 IS - 1552-6259 (Electronic) IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 87 IP - 4 DP - 2009 Apr TI - A highly articulated robotic surgical system for minimally invasive surgery. PG - 1253-6 LID - 10.1016/j.athoracsur.2008.10.026 [doi] AB - PURPOSE: We developed a novel, highly articulated robotic surgical system (CardioARM) to enable minimally invasive intrapericardial therapeutic delivery through a subxiphoid approach. We performed preliminary proof of concept studies in a porcine preparation by performing epicardial ablation. DESCRIPTION: CardioARM is a robotic surgical system having an articulated design to provide unlimited but controllable flexibility. The CardioARM consists of serially connected, rigid cyclindrical links housing flexible working ports through which catheter-based tools for therapy and imaging can be advanced. The CardioARM is controlled by a computer-driven, user interface, which is operated outside the operative field. EVALUATION: In six experimental subjects, the CardioARM was introduced percutaneously through a subxiphoid access. A commercial 5-French radiofrequency ablation catheter was introduced through the working port, which was then used to guide deployment. In all subjects, regional ("linear") left atrial ablation was successfully achieved without complications. CONCLUSIONS: Based on these preliminary studies, we believe that the CardioARM promises to enable deployment of a number of epicardium-based therapies. Improvements in imaging techniques will likely facilitate increasingly complex procedures. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. FAU - Degani, Amir AU - Degani A FAU - Schwartzman, David AU - Schwartzman D FAU - Zubiate, Brett AU - Zubiate B FAU - McGarvey, Jeremy AU - McGarvey J FAU - Choset, Howie AU - Choset H FAU - Zenati, Marco A AU - Zenati MA LA - eng GR - R01 HL079940/HL/NHLBI NIH HHS/United States GR - R01 HL079940-03/HL/NHLBI NIH HHS/United States GR - R01HL079940/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Animals MH - *Cardiac Surgical Procedures MH - Minimally Invasive Surgical Procedures MH - *Robotics MH - Swine PMC - PMC2691642 MID - NIHMS80020 EDAT- 2009/03/28 09:00 MHDA- 2009/04/14 09:00 CRDT- 2009/03/28 09:00 PHST- 2008/06/29 00:00 [received] PHST- 2008/10/12 00:00 [revised] PHST- 2008/10/14 00:00 [accepted] PHST- 2009/03/28 09:00 [entrez] PHST- 2009/03/28 09:00 [pubmed] PHST- 2009/04/14 09:00 [medline] AID - S0003-4975(08)02244-3 [pii] AID - 10.1016/j.athoracsur.2008.10.026 [doi] PST - ppublish SO - Ann Thorac Surg. 2009 Apr;87(4):1253-6. doi: 10.1016/j.athoracsur.2008.10.026. PMID- 19026821 OWN - NLM STAT- MEDLINE DCOM- 20081216 LR - 20211020 IS - 1097-685X (Electronic) IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 136 IP - 5 DP - 2008 Nov TI - A fusion protein of hepatocyte growth factor enhances reconstruction of myocardium in a cardiac patch derived from porcine urinary bladder matrix. PG - 1309-17 LID - 10.1016/j.jtcvs.2008.07.008 [doi] AB - OBJECTIVE: We sought to promote myocardial repair using urinary bladder matrix incorporated with a fusion protein that combined hepatocyte growth factor and fibronectin collagen-binding domain in a porcine model. Collagen-binding domain acted as an intermediary to promote hepatocyte growth factor binding and enhance hepatocyte growth factor stability within urinary bladder matrix. METHODS: Urinary bladder matrix incorporated with collagen-binding domain and hepatocyte growth factor was implanted into the porcine right ventricular wall (F group) to repair a surgically created defect. Untreated urinary bladder matrix patches (U group) and Dacron patches (D group) served as controls (N = 5/group). Electromechanical mapping was performed 60 days after surgery. Linear local shortening was used to assess regional contractility, and electrical activity was recorded. RESULTS: Linear local shortening was significantly improved in the F group compared with controls (F: 0.51% +/- 1.57% [P < .05], U: -1.06% +/- 1.84%, D: -2.72% +/- 2.59%), whereas it was inferior to the normal myocardium (13.7% +/- 4.3%; P < .05). Mean electrical activity was 1.49 +/- 0.82 mV in the F group, which was statistically greater than in the control groups (U: 0.93 +/- 0.71 mV; D: 0.30 +/- 0.22 mV; P < .05) and less than the normal myocardium (8.24 +/- 2.49 mV; P < .05). Histologic examination showed predominant alpha-smooth muscle actin positive cells with the F group showing the thickest layer and the D group showing the thinnest layer, with an endocardial endothelial monolayer. Scattered isolated islands of alpha-actinin positive cells were observed only in the F group, but not in the controls, suggesting the presence of cardiomyocytes. CONCLUSION: The collagen-binding domain/hepatocyte growth factor/urinary bladder matrix patch demonstrated increased contractility and electrical activity compared with urinary bladder matrix alone or Dacron and facilitated a homogeneous repopulation of host cells. Urinary bladder matrix incorporated with collagen-binding domain and hepatocyte growth factor may contribute to constructive myocardial remodeling. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA. FAU - Gilbert, Thomas W AU - Gilbert TW FAU - Schwartzman, David AU - Schwartzman D FAU - McTiernan, Charles F AU - McTiernan CF FAU - Kitajima, Takashi AU - Kitajima T FAU - Ito, Yoshihiro AU - Ito Y FAU - Sawa, Yoshiki AU - Sawa Y FAU - Badylak, Stephen F AU - Badylak SF FAU - Zenati, Marco A AU - Zenati MA LA - eng GR - R01 AR054940/AR/NIAMS NIH HHS/United States GR - R01 AR054940-02/AR/NIAMS NIH HHS/United States GR - AR053603/AR/NIAMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20080914 TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 RN - 0 (Actins) RN - 0 (Polyethylene Terephthalates) RN - 0 (Recombinant Fusion Proteins) RN - 67256-21-7 (Hepatocyte Growth Factor) RN - 9007-34-5 (Collagen) SB - IM MH - Actins/analysis MH - Animals MH - Capillaries/anatomy & histology MH - Collagen MH - Electromagnetic Phenomena MH - Extracellular Matrix MH - *Hepatocyte Growth Factor MH - Immunohistochemistry MH - Myocardium/*cytology MH - Polyethylene Terephthalates MH - Recombinant Fusion Proteins/pharmacology MH - Reverse Transcriptase Polymerase Chain Reaction MH - Swine MH - Tissue Engineering/*methods MH - Urinary Bladder PMC - PMC2723859 MID - NIHMS80779 EDAT- 2008/11/26 09:00 MHDA- 2008/12/17 09:00 CRDT- 2008/11/26 09:00 PHST- 2008/03/21 00:00 [received] PHST- 2008/05/30 00:00 [revised] PHST- 2008/07/04 00:00 [accepted] PHST- 2008/11/26 09:00 [pubmed] PHST- 2008/12/17 09:00 [medline] PHST- 2008/11/26 09:00 [entrez] AID - S0022-5223(08)01178-1 [pii] AID - 10.1016/j.jtcvs.2008.07.008 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2008 Nov;136(5):1309-17. doi: 10.1016/j.jtcvs.2008.07.008. Epub 2008 Sep 14. PMID- 14502165 OWN - NLM STAT- MEDLINE DCOM- 20031117 LR - 20190916 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 126 IP - 3 DP - 2003 Sep TI - Microelectromechanical systems for endoscopic cardiac surgery. PG - 851-2 FAU - Bonanomi, Gianluca AU - Bonanomi G AD - Department of Cardiothoracic Surgery, University of Pittsburgh, 200 Lothrop Street, Suite C-700, Pittsburgh, PA 15213, USA. bonanomig@msx.upmc.edu FAU - Rebello, Keith AU - Rebello K FAU - Lebouitz, Kyle AU - Lebouitz K FAU - Riviere, Cameron AU - Riviere C FAU - Di Martino, Elena AU - Di Martino E FAU - Vorp, David AU - Vorp D FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM MH - Animals MH - Cardiac Surgical Procedures/*instrumentation/*methods MH - Electricity MH - Endoscopy/*methods MH - Equipment Design MH - Mechanics MH - Miniaturization MH - Swine EDAT- 2003/09/23 05:00 MHDA- 2003/12/03 05:00 CRDT- 2003/09/23 05:00 PHST- 2003/09/23 05:00 [pubmed] PHST- 2003/12/03 05:00 [medline] PHST- 2003/09/23 05:00 [entrez] AID - S0022522303003933 [pii] AID - 10.1016/s0022-5223(03)00393-3 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2003 Sep;126(3):851-2. doi: 10.1016/s0022-5223(03)00393-3. PMID- 17903518 OWN - NLM STAT- MEDLINE DCOM- 20071108 LR - 20161124 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 134 IP - 4 DP - 2007 Oct TI - Impact of beating heart left atrial ablation on left-sided heart mechanics. PG - 982-8 AB - OBJECTIVE: The cut-and-sew Cox-Maze procedure is the gold standard for surgical treatment of atrial fibrillation, but it is associated with long-term impairment of left atrial mechanical function. We developed a bipolar, irrigated radiofrequency ablation device. We hypothesized that beating heart radiofrequency left atrial ablation would result in minimal acute changes in left atrial hemodynamics. METHODS: Six healthy subjects were studied. Combination pressure-conductance catheters were inserted into the left atrium and ventricle. With the use of the device, atrial ablation was performed on the beating heart without cardiopulmonary bypass, including electrical isolation of the posterior left atrium and atrial appendage myocardium. Simultaneous left-sided heart pressure-volume and intracardiac echocardiography data were acquired before ablation, after left atrial appendage ablation alone, and after all ablation (with and without appendage occlusion). The derived indices of left-sided heart mechanical function were examined. RESULTS: Relative to baseline, no significant diminishment in pressure-volume or intracardiac echocardiography-derived indices of global left-sided heart mechanical function were observed after ablation, with or without appendage occlusion. Mitral valve morphology and function were not significantly altered. A significant diminishment of atrial appendage systolic flow was noted after appendage ablation in association with spontaneous echocardiographic contrast in this region. CONCLUSIONS: In this model, ablation does not seem to compromise global left-sided heart mechanical function. However, these findings mask regional diminishment in atrial appendage systolic function. This observation demonstrates that electrical isolation of the appendage should be accompanied by its occlusion or excision. Appendage occlusion after ablation does not seem to compromise left-sided heart mechanical function. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pa 15213-2582, USA. FAU - Schwartzman, David AU - Schwartzman D FAU - Francischelli, David AU - Francischelli D FAU - Hettrick, Douglas A AU - Hettrick DA FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM MH - Analysis of Variance MH - Animals MH - Atrial Fibrillation/diagnostic imaging/*physiopathology/*surgery MH - Atrial Function, Left/*physiology MH - Catheter Ablation/*instrumentation MH - Echocardiography MH - Electrophysiologic Techniques, Cardiac MH - Female MH - Swine MH - Ventricular Function, Left/*physiology EDAT- 2007/10/02 09:00 MHDA- 2007/11/09 09:00 CRDT- 2007/10/02 09:00 PHST- 2006/12/04 00:00 [received] PHST- 2007/03/29 00:00 [revised] PHST- 2007/04/09 00:00 [accepted] PHST- 2007/10/02 09:00 [pubmed] PHST- 2007/11/09 09:00 [medline] PHST- 2007/10/02 09:00 [entrez] AID - S0022-5223(07)01076-8 [pii] AID - 10.1016/j.jtcvs.2007.04.063 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2007 Oct;134(4):982-8. doi: 10.1016/j.jtcvs.2007.04.063. PMID- 1548919 OWN - NLM STAT- MEDLINE DCOM- 19920423 LR - 20031114 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 103 IP - 4 DP - 1992 Apr TI - Donor-transmitted pneumonia in experimental lung allografts. Successful prevention with donor antibiotic therapy. PG - 767-72 AB - Bacterial pneumonia is the most common cause of early morbidity and mortality (less than 2 weeks) after heart-lung transplantation. The majority (76%) of cultures taken from human donor tracheas at the time of explant grew bacteria. The abnormal immune response of the lung allograft and the common finding of bacterial contamination of lung donors led us to hypothesize that clinically silent bacterial contamination of the donor lung progresses to pneumonia in the recipient and that antibiotic treatment of donors will prevent the development of pneumonia in the recipient. Inocula of Streptococcus pneumoniae were instilled into the left middle lobe of normal and donor dogs to identify the number of bacteria that would result in pneumonia in a normal animal and the amount that, when given to a donor, would result in pneumonia in the recipient. Initial studies established that inocula of 10(4) colony-forming units of S. pneumoniae did not result in pneumonia in normal or immunosuppressed animals. When 10(4) colony-forming units or as few as 10(2) were instilled into the left middle lobe of donors 24 hours before explantation and use of the lung for transplantation, severe acute bronchopneumonia developed in all 18 recipients. Treatment of donors with aerosol and intravenous antibiotics, but not with either alone, prevented pneumonia in the recipients. We conclude that bacterial contamination of the donor lung leads to pneumonia in recipients. Intravenous and aerosol antibiotic treatment of donors with bacterial contamination prevents pneumonia in canine lung recipients. Treatment of human donors with this antibiotic regimen may decrease the prevalence of early bacterial pneumonia. FAU - Dowling, R D AU - Dowling RD AD - Department of Surgery, University of Pittsburgh, Pa. FAU - Zenati, M AU - Zenati M FAU - Yousem, S A AU - Yousem SA FAU - Pasculle, A W AU - Pasculle AW FAU - Kormos, R L AU - Kormos RL FAU - Armitage, J A AU - Armitage JA FAU - Griffith, B P AU - Griffith BP FAU - Hardesty, R L AU - Hardesty RL LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Administration, Inhalation MH - Animals MH - Anti-Bacterial Agents/*therapeutic use MH - Dogs MH - Female MH - Infusions, Intravenous MH - *Lung Transplantation/adverse effects MH - Pneumonia, Pneumococcal/*etiology/*prevention & control MH - Tissue Donors MH - Transplantation, Homologous EDAT- 1992/04/01 00:00 MHDA- 1992/04/01 00:01 CRDT- 1992/04/01 00:00 PHST- 1992/04/01 00:00 [pubmed] PHST- 1992/04/01 00:01 [medline] PHST- 1992/04/01 00:00 [entrez] PST - ppublish SO - J Thorac Cardiovasc Surg. 1992 Apr;103(4):767-72. PMID- 17382638 OWN - NLM STAT- MEDLINE DCOM- 20070417 LR - 20070326 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 133 IP - 4 DP - 2007 Apr TI - Electromechanical characterization of a tissue-engineered myocardial patch derived from extracellular matrix. PG - 979-85 AB - OBJECTIVE: Extracellular matrix scaffolds have been successfully used for myocardial wall repair. However, regional functional evaluation (ie, contractility, electrical conductivity) of the extracellular matrix scaffold during the course of remodeling has been limited. In the present study, we evaluated the remodeled scaffold for evidence of electrical activation. METHODS: The extracellular matrix patch was implanted into the porcine right ventricular wall (n = 5) to repair an experimentally produced defect. Electromechanical mapping was performed with the NOGA system (Biosense Webster Inc, Diamond Bar, Calif) 60 days after implantation. Linear local shortening was recorded to assess regional contractility. After sacrifice, detailed histologic examinations were performed. RESULTS: Histologic examinations showed repopulation of the scaffold with cells, including a monolayer of factor VIII-positive cells in the endocardial surface and multilayered alpha-smooth muscle actin-positive cells beneath the monolayer cells. The alpha-smooth muscle actin-positive cells tended to be present at the endocardial aspect of the remodeled scaffold and at the border between the remodeled scaffold and the normal myocardium. Electromechanical mapping demonstrated that the patch had low-level electrical activity (0.56 +/- 0.37 mV; P < .0001) in most areas and moderate activity (2.20 +/- 0.70 mV; P < .0001) in the margin between the patch and the normal myocardium (7.58 +/- 2.23 mV). CONCLUSIONS: The extracellular matrix scaffolds were repopulated by alpha-smooth muscle actin-positive cells 60 days after implantation into the porcine heart. The presence of the cells corresponded to areas of the remodeling scaffold that showed early signs of electrical conductivity. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pa 15213, USA. FAU - Gilbert, Thomas W AU - Gilbert TW FAU - Badylak, Stephen F AU - Badylak SF FAU - Schwartzman, David AU - Schwartzman D FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM MH - Animals MH - Disease Models, Animal MH - *Electrocardiography MH - Extracellular Matrix/pathology/*physiology/transplantation MH - Heart/*physiology MH - Myocardium/pathology MH - *Regeneration MH - Swine MH - *Tissue Engineering MH - Ventricular Remodeling/*physiology EDAT- 2007/03/27 09:00 MHDA- 2007/04/18 09:00 CRDT- 2007/03/27 09:00 PHST- 2006/05/20 00:00 [received] PHST- 2006/11/06 00:00 [revised] PHST- 2006/11/14 00:00 [accepted] PHST- 2007/03/27 09:00 [pubmed] PHST- 2007/04/18 09:00 [medline] PHST- 2007/03/27 09:00 [entrez] AID - S0022-5223(06)02276-8 [pii] AID - 10.1016/j.jtcvs.2006.11.035 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2007 Apr;133(4):979-85. doi: 10.1016/j.jtcvs.2006.11.035. PMID- 18721601 OWN - NLM STAT- MEDLINE DCOM- 20080919 LR - 20080825 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 86 IP - 3 DP - 2008 Sep TI - Highly fenestrated septum primum leads to failure of Amplatzer septal defect closure. PG - 998-1000 LID - 10.1016/j.athoracsur.2008.02.077 [doi] AB - A patient presenting with a history of transient ischemic attacks was initially diagnosed with a large secundum-type atrial septal defect by transesophageal echocardiography. Subsequent attempts to percutaneously repair the defect using an Amplatzer septal occlude device (AGA Medical, Plymouth, MN) failed to position correctly on multiple attempts. At the time of surgery, a largely deficient and highly fenestrated septum primum was found, which was likely the cause of the Amplatzer device (AGA Medical) failure. The defect was then definitively repaired using a bovine pericardial patch without incident. FAU - McGarvey, Jeremy AU - McGarvey J AD - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Ota, Takeyoshi AU - Ota T FAU - Anderson, William AU - Anderson W FAU - Katz, William AU - Katz W FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Case Reports PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Animals MH - Bioprosthesis MH - Cattle MH - Echocardiography, Transesophageal MH - Female MH - Heart Septal Defects/*surgery MH - Humans MH - Middle Aged MH - Pericardium/transplantation MH - *Prostheses and Implants MH - Prosthesis Failure MH - Reoperation EDAT- 2008/08/30 09:00 MHDA- 2008/09/20 09:00 CRDT- 2008/08/30 09:00 PHST- 2008/02/08 00:00 [received] PHST- 2008/02/21 00:00 [revised] PHST- 2008/02/25 00:00 [accepted] PHST- 2008/08/30 09:00 [pubmed] PHST- 2008/09/20 09:00 [medline] PHST- 2008/08/30 09:00 [entrez] AID - S0003-4975(08)00452-9 [pii] AID - 10.1016/j.athoracsur.2008.02.077 [doi] PST - ppublish SO - Ann Thorac Surg. 2008 Sep;86(3):998-1000. doi: 10.1016/j.athoracsur.2008.02.077. PMID- 14688697 OWN - NLM STAT- MEDLINE DCOM- 20040122 LR - 20190917 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 126 IP - 6 DP - 2003 Dec TI - A new device for beating heart bipolar radiofrequency atrial ablation. PG - 1859-66 AB - OBJECTIVE: A technique for mimicking left atrial atriotomies using an ablation device that can be deployed without cardiopulmonary bypass has been developed. METHODS: In 12 healthy large (35-50 kg) adult pigs, maze-like ablation lesions were directly applied to the left atrial epicardium on the beating heart. The ablation device is irrigated, with a bipolar "hemostat" morphology, utilizing radiofrequency energy. Prior to and after ablation, left atrial electromechanical properties were measured during sinus rhythm in the latest 5 pigs using percutaneous endocardial catheter electromechanical mapping and intracardiac echocardiography. Pathologic analysis was performed acutely. RESULTS: All ablation lesions demonstrated conduction block along their entire course. Global left atrial conduction time (49.4 +/- 8.8 milliseconds before vs 58.8 +/- 9 milliseconds after) and pattern were not significantly altered. Although a significant amount (17.12% +/- 9%) of myocardium was either ablated or electrically isolated, ablation was not associated with significant alterations in global left atrial mechanics (left atrium ejection fraction 19% before vs 17% after; pulmonary vein peak flow velocity 1.22 m/s before vs 1.38 m/s after; peak mitral inflow velocity 2.34 m/s before vs 2.64 m/s after), mitral valve function, nor left ventricular function. There was no evidence of atrial thrombus formation. Transmurality was achieved in most lesions with no evidence of charring or barotrauma. CONCLUSIONS: Utilizing this ablation device, atrial lesions similar to the left component of the Maze procedure were deployed with uniform success in a beating heart without cardiopulmonary bypass or atriotomy and without adverse effects on left atrial electromechanics. FAU - Bonanomi, Gianluca AU - Bonanomi G AD - Division of Cardiothoracic Surgery, University of Pittsburgh, PA 15213, USA. FAU - Schwartzman, David AU - Schwartzman D FAU - Francischelli, David AU - Francischelli D FAU - Hebsgaard, Kim AU - Hebsgaard K FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM MH - Animals MH - Cardiac Pacing, Artificial MH - Catheter Ablation/*instrumentation/methods MH - Echocardiography MH - Electrocardiography MH - Electrophysiologic Techniques, Cardiac MH - Heart Atria/physiopathology/*surgery MH - Swine EDAT- 2003/12/23 05:00 MHDA- 2004/01/24 05:00 CRDT- 2003/12/23 05:00 PHST- 2003/12/23 05:00 [pubmed] PHST- 2004/01/24 05:00 [medline] PHST- 2003/12/23 05:00 [entrez] AID - S0022-5223(03)01305-9 [pii] AID - 10.1016/s0022-5223(03)01305-9 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2003 Dec;126(6):1859-66. doi: 10.1016/s0022-5223(03)01305-9. PMID- 18805205 OWN - NLM STAT- MEDLINE DCOM- 20081022 LR - 20141120 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 86 IP - 4 DP - 2008 Oct TI - Minimally invasive epicardial left atrial ablation and appendectomy for refractory atrial tachycardia. PG - 1375-7 LID - 10.1016/j.athoracsur.2008.04.006 [doi] AB - Surgical removal or epicardial radiofrequency ablation of the left atrial appendage (LAA) is occasionally required when endocardial ablations fail. We report a modified minimally invasive surgical approach for elimination of recurrent atrial arrhythmias arising from the LAA, including both radiofrequency ablation and appendectomy. Ablation of the LAA base was performed using the Medtronic Cardioblate bipolar radiofrequency device (Medtronic, Minneapolis, MN), and left atrial appendectomy was then completed using the EndoGIA stapling system (US Surgical, Norwalk, CT). This procedure successfully isolated and removed the tachycardia focus, and normal sinus rhythm was restored. Elimination of LAA arrhythmias using a combination of epicardial radiofrequency ablation and appendectomy ensures electrical isolation while minimizing surgical invasiveness. FAU - McGarvey, Jeremy R AU - McGarvey JR AD - Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. FAU - Schwartzman, David AU - Schwartzman D FAU - Ota, Takeyoshi AU - Ota T FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Case Reports PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Atrial Appendage/physiopathology/*surgery MH - Atrial Fibrillation/diagnosis/*surgery MH - Catheter Ablation/*methods MH - Combined Modality Therapy MH - Electrocardiography MH - Female MH - Follow-Up Studies MH - Humans MH - Middle Aged MH - Minimally Invasive Surgical Procedures/methods MH - Risk Assessment MH - Severity of Illness Index MH - Tachycardia, Supraventricular/diagnosis/*surgery MH - Treatment Outcome EDAT- 2008/09/23 09:00 MHDA- 2008/10/23 09:00 CRDT- 2008/09/23 09:00 PHST- 2008/02/12 00:00 [received] PHST- 2008/03/27 00:00 [revised] PHST- 2008/04/03 00:00 [accepted] PHST- 2008/09/23 09:00 [pubmed] PHST- 2008/10/23 09:00 [medline] PHST- 2008/09/23 09:00 [entrez] AID - S0003-4975(08)00740-6 [pii] AID - 10.1016/j.athoracsur.2008.04.006 [doi] PST - ppublish SO - Ann Thorac Surg. 2008 Oct;86(4):1375-7. doi: 10.1016/j.athoracsur.2008.04.006. PMID- 9628687 OWN - NLM STAT- MEDLINE DCOM- 19980629 LR - 20190914 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 115 IP - 6 DP - 1998 Jun TI - Resident training and minimally invasive cardiac surgery. PG - 1390 FAU - Zenati, M AU - Zenati M FAU - Spier, L AU - Spier L FAU - Gammie, J S AU - Gammie JS FAU - Griffith, B P AU - Griffith BP LA - eng PT - Comment PT - Letter PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM CON - J Thorac Cardiovasc Surg. 1997 Sep;114(3):419-20. PMID: 9305194 MH - Cardiac Surgical Procedures/*education MH - Cardiology/*education MH - Coronary Artery Bypass/methods MH - Education MH - Humans MH - *Internship and Residency MH - Minimally Invasive Surgical Procedures EDAT- 1998/06/17 00:00 MHDA- 1998/06/17 00:01 CRDT- 1998/06/17 00:00 PHST- 1998/06/17 00:00 [pubmed] PHST- 1998/06/17 00:01 [medline] PHST- 1998/06/17 00:00 [entrez] AID - S0022522398702284 [pii] AID - 10.1016/s0022-5223(98)70228-4 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 1998 Jun;115(6):1390. doi: 10.1016/s0022-5223(98)70228-4. PMID- 11603472 OWN - NLM STAT- MEDLINE DCOM- 20011204 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 72 IP - 4 DP - 2001 Oct TI - Minimally invasive coronary bypass without general endotracheal anesthesia. PG - 1380-2 AB - This report describes the case of a 51-year-old man with myocardial ischemia resulting from in-stent restenosis of the left anterior descending coronary artery who underwent a minimally invasive direct coronary artery bypass using thoracic epidural analgesia while awake, without general endotracheal anesthesia. FAU - Zenati, M A AU - Zenati MA AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center and Veterans Affairs Healthcare System, Pennsylvania 15213, USA. zenatim@msx.upmc.edu FAU - Paiste, J AU - Paiste J FAU - Williams, J P AU - Williams JP FAU - Strindberg, G AU - Strindberg G FAU - Dumouchel, J P AU - Dumouchel JP FAU - Griffith, B P AU - Griffith BP LA - eng PT - Case Reports PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Anesthesia, Endotracheal MH - *Anesthesia, Epidural MH - *Coronary Artery Bypass MH - Graft Occlusion, Vascular/*surgery MH - Humans MH - Male MH - Middle Aged MH - *Minimally Invasive Surgical Procedures MH - Reoperation MH - *Stents EDAT- 2001/10/18 10:00 MHDA- 2002/01/05 10:01 CRDT- 2001/10/18 10:00 PHST- 2001/10/18 10:00 [pubmed] PHST- 2002/01/05 10:01 [medline] PHST- 2001/10/18 10:00 [entrez] AID - S0003-4975(00)02474-7 [pii] AID - 10.1016/s0003-4975(00)02474-7 [doi] PST - ppublish SO - Ann Thorac Surg. 2001 Oct;72(4):1380-2. doi: 10.1016/s0003-4975(00)02474-7. PMID- 9766586 OWN - NLM STAT- MEDLINE DCOM- 19981020 LR - 20190915 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 116 IP - 4 DP - 1998 Oct TI - Preoperative risk models for minimally invasive coronary bypass: a preliminary study. PG - 584-9 AB - OBJECTIVE: Available risk assessment models are designed for standard coronary artery bypass grafting. We hypothesized that minimally invasive coronary bypass could improve on predicted outcome in extremely high-risk patients (Parsonnet score > 20%) by the current risk models. METHODS: From September 1996 to September 1997, 27 consecutive extremely high-risk patients underwent minimally invasive coronary bypass. Seventeen patients were male; age was 73 +/- 12 years, and 63% of patients were older than 75 years. Left ventricular ejection fraction was 33.7% +/- 15% and 63% had an ejection fraction of less than 35%. The predicted 30-day mortality according to the System 97 model was 25.6% +/- 11.3%. The Parsonnet risk score was 36.2% +/- 11%; the predicted length of stay in the hospital was 15.3 +/- 3 days. The predicted risk of stroke according to the Multicenter Perioperative Stroke Risk Index was 22.3% +/- 11.7%. RESULTS: Minimally invasive coronary bypass was isolated in 20 patients and integrated with angioplasty and stenting in 7 patients. The observed 30-day mortality was 0% (P < .01 vs predicted): at an average follow-up of 10.8 +/- 4.1 months, 26 patients (96.3%) are alive without angina; one patient with acquired immunodeficiency syndrome died on postoperative day 40 of acute pancreatitis. No patient had a stroke or neurologic deficit (P < .01 vs predicted). Patency of internal thoracic artery anastomosis was confirmed by angiography in all 27 patients. No patient required reoperation. Eighteen patients (67%) were extubated in the operating room. The observed length of hospital stay after minimally invasive coronary bypass was 3.8 +/- 2.6 days (P < .01 vs predicted). CONCLUSION: On the basis of our results on a relatively small series of patients, we suggest that risk models geared for standard coronary bypass grafting may not be appropriate for minimally invasive coronary bypass. FAU - Zenati, M AU - Zenati M AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA 15213-2582, USA. FAU - Cohen, H A AU - Cohen HA FAU - Holubkov, R AU - Holubkov R FAU - Smith, A J AU - Smith AJ FAU - Boujoukos, A J AU - Boujoukos AJ FAU - Caldwell, J AU - Caldwell J FAU - Firestone, L AU - Firestone L FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - IM MH - Aged MH - Aged, 80 and over MH - Angioplasty, Balloon, Coronary/mortality MH - Cause of Death MH - Cerebrovascular Disorders/mortality MH - Combined Modality Therapy MH - Coronary Artery Bypass/*mortality MH - Coronary Disease/mortality/*surgery MH - Female MH - Hospital Mortality MH - Humans MH - Length of Stay/statistics & numerical data MH - Male MH - Middle Aged MH - Minimally Invasive Surgical Procedures/*mortality MH - Postoperative Complications/*mortality MH - Risk Assessment MH - Stents/statistics & numerical data MH - Treatment Outcome EDAT- 1998/10/10 00:00 MHDA- 1998/10/10 00:01 CRDT- 1998/10/10 00:00 PHST- 1998/10/10 00:00 [pubmed] PHST- 1998/10/10 00:01 [medline] PHST- 1998/10/10 00:00 [entrez] AID - S0022-5223(98)70164-3 [pii] AID - 10.1016/s0022-5223(98)70164-3 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 1998 Oct;116(4):584-9. doi: 10.1016/s0022-5223(98)70164-3. PMID- 7995827 OWN - NLM STAT- MEDLINE DCOM- 19950118 LR - 20211203 IS - 0021-9509 (Print) IS - 0021-9509 (Linking) VI - 35 IP - 5 DP - 1994 Oct TI - Results of heart transplantation by extending recipient selection criteria. PG - 377-82 AB - From November 1985 to July 1993, 29 out of 241 patients (12%) who underwent heart transplantation (HTx) at our institution had one or more "classical" contraindications to HTx: age > or = 60 years (20 patients); insulin-dependent diabetes mellitus (5 patients); irreversible renal failure requiring combined heart-kidney transplantation (2 patients); previous surgery for malignancy (1 patient); familial hypercholesterolemia (1 patient) and active systemic infection (1 patient). The main indication for HTx was ischemic cardiomyopathy (21 patients, 61%). Immunosuppression regimen consisted of Cyclosporine and Azathioprine, oral prednisone being subsequently added in 6 patients because of persistent rejection. There were 2 perioperative deaths and one late death. Follow-up ranged from 1 to 88 months (mean, 28 +/- 20) with an actuarial survival at 5 years of 85 +/- 8%. Annual cardiac catheterization demonstrated normal graft function and coronary arteries in all. No significant differences in survival, incidence of rejection and infection, renal function and duration of hospitalization were found when these patients were compared with those with no contraindications to HTx. In conclusion, HTx can be performed with good early clinical results in selected patients with "classical" contraindications to HTx; longer follow-up, however, is needed to confirm whether extension of the recipient selection criteria justified. FAU - Livi, U AU - Livi U AD - Department of Cardiovascular Surgery, University of Padua Medical School, Italy. FAU - Milano, A AU - Milano A FAU - Bortolotti, U AU - Bortolotti U FAU - Casula, R AU - Casula R FAU - Zenati, M AU - Zenati M FAU - Casarotto, D AU - Casarotto D LA - eng PT - Journal Article PL - Italy TA - J Cardiovasc Surg (Torino) JT - The Journal of cardiovascular surgery JID - 0066127 SB - IM MH - Adult MH - Contraindications MH - Female MH - *Heart Transplantation/mortality/statistics & numerical data MH - Humans MH - Immunosuppression Therapy MH - Italy/epidemiology MH - Male MH - Middle Aged MH - *Patient Selection MH - Postoperative Care MH - Postoperative Complications/epidemiology MH - Risk Factors MH - Statistics as Topic MH - Survivors/statistics & numerical data EDAT- 1994/10/01 00:00 MHDA- 1994/10/01 00:01 CRDT- 1994/10/01 00:00 PHST- 1994/10/01 00:00 [pubmed] PHST- 1994/10/01 00:01 [medline] PHST- 1994/10/01 00:00 [entrez] PST - ppublish SO - J Cardiovasc Surg (Torino). 1994 Oct;35(5):377-82. PMID- 24633760 OWN - NLM STAT- MEDLINE DCOM- 20150929 LR - 20211021 IS - 1932-8737 (Electronic) IS - 0160-9289 (Print) IS - 0160-9289 (Linking) VI - 37 IP - 6 DP - 2014 Jun TI - Choice of vein-harvest technique for coronary artery bypass grafting: rationale and design of the REGROUP trial. PG - 325-30 LID - 10.1002/clc.22267 [doi] AB - The Randomized Endo-vein Graft Prospective (REGROUP) trial (ClinicalTrials.gov NCT01850082) is a randomized, intent-to-treat, 2-arm, parallel-design, multicenter study funded by the Cooperative Studies Program (CSP No. 588) of the US Department of Veterans Affairs. Cardiac surgeons at 16 Veterans Affairs (VA) medical centers with technical expertise in performing both endoscopic vein harvesting (EVH) and open vein harvesting (OVH) were recruited as the REGROUP surgeon participants. Subjects requiring elective or urgent coronary artery bypass grafting using cardiopulmonary bypass with use of ≥1 saphenous vein graft will be screened for enrollment using pre-established inclusion/exclusion criteria. Enrolled subjects (planned N = 1150) will be randomized to 1 of the 2 arms (EVH or OVH) after an experienced vein harvester has been assigned. The primary outcomes measure is the rate of major adverse cardiac events (MACE), including death, myocardial infarction, or revascularization. Subject assessments will be performed at multiple times, including at baseline, intraoperatively, postoperatively, and at discharge (or 30 days after surgery, if still hospitalized). Assessment of leg-wound complications will be completed at 6 weeks after surgery. Telephone follow-ups will occur at 3-month intervals after surgery until the participating sites are decommissioned after the trial's completion (approximately 4.5 years after the full study startup). To assess long-term outcomes, centralized follow-up of MACE for 2 additional years will be centrally performed using VA and non-VA clinical and administrative databases. The primary MACE outcome will be compared between the 2 arms, EVH and OVH, at the end of the trial duration. CI - Published 2014. This article is a U.S. Government work and is in the public domain in the USA. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiothoracic Surgery, Surgical Service, Veterans Affairs Boston Healthcare System. FAU - Gaziano, J Michael AU - Gaziano JM FAU - Collins, Joseph F AU - Collins JF FAU - Biswas, Kousick AU - Biswas K FAU - Gabany, Jennifer M AU - Gabany JM FAU - Quin, Jacquelyn A AU - Quin JA FAU - Bitondo, Jerene M AU - Bitondo JM FAU - Bakaeen, Faisal G AU - Bakaeen FG FAU - Kelly, Rosemary F AU - Kelly RF FAU - Shroyer, A Laurie AU - Shroyer AL FAU - Bhatt, Deepak L AU - Bhatt DL LA - eng SI - ClinicalTrials.gov/NCT01850082 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20140314 TA - Clin Cardiol JT - Clinical cardiology JID - 7903272 SB - IM MH - Adult MH - Coronary Artery Bypass/*methods MH - Endoscopy/methods MH - Humans MH - Research Design MH - Saphenous Vein/*transplantation MH - Tissue and Organ Harvesting/*methods PMC - PMC6649498 EDAT- 2014/03/19 06:00 MHDA- 2015/09/30 06:00 CRDT- 2014/03/18 06:00 PHST- 2013/12/10 00:00 [received] PHST- 2014/01/24 00:00 [revised] PHST- 2014/03/18 06:00 [entrez] PHST- 2014/03/19 06:00 [pubmed] PHST- 2015/09/30 06:00 [medline] AID - CLC22267 [pii] AID - 10.1002/clc.22267 [doi] PST - ppublish SO - Clin Cardiol. 2014 Jun;37(6):325-30. doi: 10.1002/clc.22267. Epub 2014 Mar 14. PMID- 27154150 OWN - NLM STAT- MEDLINE DCOM- 20170330 LR - 20181113 IS - 1552-6259 (Electronic) IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 102 IP - 3 DP - 2016 Sep TI - Design of a Coupled Thermoresponsive Hydrogel and Robotic System for Postinfarct Biomaterial Injection Therapy. PG - 780-786 LID - S0003-4975(16)00267-8 [pii] LID - 10.1016/j.athoracsur.2016.02.082 [doi] AB - BACKGROUND: In preclinical testing, ventricular wall injection of hydrogels has been shown to be effective in modulating ventricular remodeling and preserving cardiac function. For some approaches, early-stage clinical trials are under way. The hydrogel delivery method varies, with minimally invasive approaches being preferred. Endocardial injections carry a risk of hydrogel regurgitation into the circulation, and precise injection patterning is a challenge. An epicardial approach with a thermally gelling hydrogel through the subxiphoid pathway overcomes these disadvantages. METHODS: A relatively stiff, thermally responsive, injectable hydrogel based on N-isopropylacrylamide and N-vinylpyrrolidone (VP gel) was synthesized and characterized. VP gel thermal behavior was tuned to couple with a transepicardial injection robot, incorporating a cooling feature to achieve injectability. Ventricular wall injections of the optimized VP gel have been performed ex vivo and on beating porcine hearts. RESULTS: Thermal transition temperature, viscosity, and gelling time for the VP gel were manipulated by altering N-vinylpyrrolidone content. The target parameters for cooling in the robotic system were chosen by thermal modeling to support smooth, repeated injections on an ex vivo heart. Injections at predefined locations and depth were confirmed in an infarcted porcine model. CONCLUSIONS: A coupled thermoresponsive hydrogel and robotic injection system incorporating a temperature-controlled injectate line was capable of targeted injections and amenable to use with a subxiphoid transepicardial approach for hydrogel injection after myocardial infarction. The confirmation of precise location and depth injections would facilitate a patient-specific planning strategy to optimize injection patterning to maximize the mechanical benefits of hydrogel placement. CI - Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Zhu, Yang AU - Zhu Y AD - McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania. FAU - Fok, Kevin AU - Fok K AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania. FAU - Yoshizumi, Tomo AU - Yoshizumi T AD - McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Park, Dae Woo AU - Park DW AD - Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Jiang, Hongbin AU - Jiang H AD - McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Schwartzman, David S AU - Schwartzman DS AD - Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Zenati, Marco A AU - Zenati MA AD - Department of Surgery, Harvard University, Boston, Massachusetts. FAU - Uchibori, Takafumi AU - Uchibori T AD - McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Wagner, William R AU - Wagner WR AD - McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: wagnerwr@upmc.edu. FAU - Riviere, Cameron N AU - Riviere CN AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania. LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20160504 TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R RN - 0 (Biocompatible Materials) RN - 0 (Pyrrolidinones) RN - 25852-47-5 (Hydrogel, Polyethylene Glycol Dimethacrylate) RN - 76H9G81541 (N-vinyl-2-pyrrolidinone) SB - IM MH - Animals MH - Biocompatible Materials/*administration & dosage MH - Hydrogel, Polyethylene Glycol Dimethacrylate/*administration & dosage MH - Injections MH - Myocardial Infarction/pathology/*therapy MH - Pyrrolidinones MH - *Robotics MH - Swine MH - *Ventricular Remodeling PMC - PMC4995147 MID - NIHMS791531 EDAT- 2016/05/08 06:00 MHDA- 2017/03/31 06:00 CRDT- 2016/05/08 06:00 PHST- 2015/10/05 00:00 [received] PHST- 2016/01/21 00:00 [revised] PHST- 2016/02/22 00:00 [accepted] PHST- 2016/05/08 06:00 [entrez] PHST- 2016/05/08 06:00 [pubmed] PHST- 2017/03/31 06:00 [medline] AID - S0003-4975(16)00267-8 [pii] AID - 10.1016/j.athoracsur.2016.02.082 [doi] PST - ppublish SO - Ann Thorac Surg. 2016 Sep;102(3):780-786. doi: 10.1016/j.athoracsur.2016.02.082. Epub 2016 May 4. PMID- 30369328 OWN - NLM STAT- MEDLINE DCOM- 20191121 LR - 20210109 IS - 2047-9980 (Electronic) IS - 2047-9980 (Linking) VI - 7 IP - 16 DP - 2018 Aug 21 TI - Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate. PG - e009934 LID - 10.1161/JAHA.118.009934 [doi] LID - e009934 FAU - Gaudino, Mario AU - Gaudino M AD - 1 Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York City NY. FAU - Angelini, Gianni D AU - Angelini GD AD - 2 Bristol Heart Institute University of Bristol United Kingdom. FAU - Antoniades, Charalambos AU - Antoniades C AD - 3 University of Oxford United Kingdom. FAU - Bakaeen, Faisal AU - Bakaeen F AD - 4 Cleveland Clinic Cleveland OH. FAU - Benedetto, Umberto AU - Benedetto U AD - 2 Bristol Heart Institute University of Bristol United Kingdom. FAU - Calafiore, Antonio M AU - Calafiore AM AD - 5 Cardiac Surgery Pope John Paul II Foundation Campobasso Italy. FAU - Di Franco, Antonino AU - Di Franco A AD - 1 Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York City NY. FAU - Di Mauro, Michele AU - Di Mauro M AD - 6 Cardiovascular Disease Institute University of L'Aquila Italy. FAU - Fremes, Stephen E AU - Fremes SE AD - 7 Schulich Heart Centre Sunnybrook Health Science University of Toronto Canada. FAU - Girardi, Leonard N AU - Girardi LN AD - 1 Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York City NY. FAU - Glineur, David AU - Glineur D AD - 8 Division of Cardiac Surgery Ottawa Heart Institute Ottawa Canada. FAU - Grau, Juan AU - Grau J AD - 8 Division of Cardiac Surgery Ottawa Heart Institute Ottawa Canada. FAU - He, Guo-Wei AU - He GW AD - 9 TEDA International Cardiovascular Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China. FAU - Patrono, Carlo AU - Patrono C AD - 10 Department of Pharmacology Catholic University School of Medicine Rome Italy. FAU - Puskas, John D AU - Puskas JD AD - 11 Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York City NY. FAU - Ruel, Marc AU - Ruel M AD - 12 University of Ottawa Heart Institute Ottawa Canada. FAU - Schwann, Thomas A AU - Schwann TA AD - 13 University of Toledo College of Medicine Toledo OH. FAU - Tam, Derrick Y AU - Tam DY AD - 7 Schulich Heart Centre Sunnybrook Health Science University of Toronto Canada. FAU - Tatoulis, James AU - Tatoulis J AD - 14 Department of Surgery University of Melbourne Parkville Australia. FAU - Tranbaugh, Robert AU - Tranbaugh R AD - 1 Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York City NY. FAU - Vallely, Michael AU - Vallely M AD - 15 Sydney Medical School The University of Sydney Australia. FAU - Zenati, Marco A AU - Zenati MA AD - 16 Harvard Medical School Boston MA. FAU - Mack, Michael AU - Mack M AD - 17 The Heart Hospital Baylor Plano Plano TX. FAU - Taggart, David P AU - Taggart DP AD - 3 University of Oxford United Kingdom. CN - Arterial Grafting International Consortium (ATLANTIC) Alliance LA - eng GR - PG/13/56/30383/BHF_/British Heart Foundation/United Kingdom GR - PG/13/9/29990/BHF_/British Heart Foundation/United Kingdom GR - FS/16/15/32047/BHF_/British Heart Foundation/United Kingdom GR - PG/15/95/31853/BHF_/British Heart Foundation/United Kingdom GR - MR/J015350/1/MRC_/Medical Research Council/United Kingdom GR - PG/11/19/28827/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Review TA - J Am Heart Assoc JT - Journal of the American Heart Association JID - 101580524 SB - IM MH - Blood Coagulation MH - Cardiopulmonary Bypass MH - Coronary Artery Bypass/economics/methods MH - Coronary Artery Bypass, Off-Pump/economics/*methods MH - Coronary Artery Disease/*surgery MH - Health Care Costs MH - Humans MH - Inflammation MH - Platelet Activation MH - Treatment Outcome PMC - PMC6201399 OTO - NOTNLM OT - *coronary artery bypass grafting OT - *off‐pump OT - *off‐pump coronary artery bypass EDAT- 2018/10/30 06:00 MHDA- 2019/11/22 06:00 CRDT- 2018/10/30 06:00 PHST- 2018/10/30 06:00 [entrez] PHST- 2018/10/30 06:00 [pubmed] PHST- 2019/11/22 06:00 [medline] AID - JAH33429 [pii] AID - 10.1161/JAHA.118.009934 [doi] PST - ppublish SO - J Am Heart Assoc. 2018 Aug 21;7(16):e009934. doi: 10.1161/JAHA.118.009934. PMID- 30428397 OWN - NLM STAT- MEDLINE DCOM- 20200113 LR - 20200113 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 73 IP - 6 DP - 2019 Feb 19 TI - The "Fragility" of Mortality Benefit of Coronary Artery Bypass Graft Surgery in Diabetics. PG - 639-642 LID - S0735-1097(18)39064-8 [pii] LID - 10.1016/j.jacc.2018.11.006 [doi] FAU - Bangalore, Sripal AU - Bangalore S AD - Division of Cardiology, New York University School of Medicine, New York, New York. Electronic address: sripalbangalore@gmail.com. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiothoracic Surgery, Harvard Medical School, Boston, Massachusetts. LA - eng PT - Comment PT - Editorial DEP - 20181111 PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM CON - J Am Coll Cardiol. 2019 Feb 19;73(6):629-638. PMID: 30428398 MH - *Coronary Artery Bypass MH - *Diabetes Mellitus MH - Freedom MH - Humans OTO - NOTNLM OT - *diabetes OT - *stents OT - *surgery EDAT- 2018/11/15 06:00 MHDA- 2020/01/14 06:00 CRDT- 2018/11/15 06:00 PHST- 2018/11/04 00:00 [received] PHST- 2018/11/05 00:00 [accepted] PHST- 2018/11/15 06:00 [pubmed] PHST- 2020/01/14 06:00 [medline] PHST- 2018/11/15 06:00 [entrez] AID - S0735-1097(18)39064-8 [pii] AID - 10.1016/j.jacc.2018.11.006 [doi] PST - ppublish SO - J Am Coll Cardiol. 2019 Feb 19;73(6):639-642. doi: 10.1016/j.jacc.2018.11.006. Epub 2018 Nov 11. PMID- 15869683 OWN - NLM STAT- MEDLINE DCOM- 20050913 LR - 20071114 IS - 0147-8389 (Print) IS - 0147-8389 (Linking) VI - 28 IP - 5 DP - 2005 May TI - Utility of echocardiographic tissue synchronization imaging to redirect left ventricular lead placement for improved cardiac resynchronization therapy. PG - 461-5 AB - An 80-year-old woman with severe symptomatic heart failure (ejection fraction of 13%), and left bundle branch block (QRS duration of 160 ms) underwent cardiac resynchronization therapy (CRT). She had significant baseline dyssynchrony with a septal to posterior wall delay of 160 ms by echocardiographic tissue synchronization imaging (TSI). Despite exhaustive efforts, a stable posterior-lateral coronary vein lead position could not be achieved with the standard percutaneous approach, resulting in anterior coronary vein lead placement. This resulted in no improvement in the patient's symptoms or ventricular function. Follow-up TSI revealed earlier activation of the anteroseptal site and worsened dyssynchrony with septal to posterior wall delay of now 290 ms. This information prompted surgical revision of the left ventricular (LV) lead position via limited thoracotomy and posterior-lateral epicardial lead implantation. Pacing at the new lead site resulted in a 30% increase in stroke volume and symptomatic improvement. TSI in this case redirected lead position in a clinical nonresponder, resulting in a favorable response to CRT. FAU - Dohi, Kaoru AU - Dohi K AD - University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA. FAU - Suffoletto, Matthew AU - Suffoletto M FAU - Ganz, Leonard AU - Ganz L FAU - Zenati, Marco AU - Zenati M FAU - Gorcsan, John 3rd AU - Gorcsan J 3rd LA - eng GR - K24 HL04503-01/HL/NHLBI NIH HHS/United States GR - R01 HL073198-01/HL/NHLBI NIH HHS/United States PT - Case Reports PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Pacing Clin Electrophysiol JT - Pacing and clinical electrophysiology : PACE JID - 7803944 SB - IM MH - Aged MH - Bundle-Branch Block/therapy MH - Cardiac Pacing, Artificial/adverse effects/*methods MH - Cardiomyopathies/therapy MH - *Echocardiography, Doppler MH - Female MH - Humans EDAT- 2005/05/05 09:00 MHDA- 2005/09/15 09:00 CRDT- 2005/05/05 09:00 PHST- 2005/05/05 09:00 [pubmed] PHST- 2005/09/15 09:00 [medline] PHST- 2005/05/05 09:00 [entrez] AID - PACE40056 [pii] AID - 10.1111/j.1540-8159.2005.40056.x [doi] PST - ppublish SO - Pacing Clin Electrophysiol. 2005 May;28(5):461-5. doi: 10.1111/j.1540-8159.2005.40056.x. PMID- 22255552 OWN - NLM STAT- MEDLINE DCOM- 20120618 LR - 20211021 IS - 2694-0604 (Electronic) IS - 1557-170X (Print) IS - 2375-7477 (Linking) VI - 2011 DP - 2011 TI - Toward a hybrid snake robot for single-port surgery. PG - 5372-5 LID - 10.1109/IEMBS.2011.6091329 [doi] AB - We propose a new snake-like robot for use in single-port minimally invasive surgery. The snake robot is made of a concentric tube robot and a highly articulated robotic probe. The probe operates as a stiff shield for the concentric tube robot. Consequently, the snake robot provides simultaneously high tip stiffness and dexterity that cannot be obtained by the single use of any of two robots. A critical design challenge is achieving a small radius of curvature for the hybrid snake. A mechanic model is presented for computing the minimum achievable radius of curvature for the hybrid snake. Experiments validate the mechanic model. FAU - Mahvash, Mohsen AU - Mahvash M AD - Cardiac Surgery Department, Harvard Medical School, Brigham and Women’s Hospital and Boston Va Medical Ctr-W Roxbury, Boston, MA, USA. mahvash@hms.harvard.edu FAU - Zenati, Marco AU - Zenati M LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL079940/HL/NHLBI NIH HHS/United States GR - R01 HL079940-01A2/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - Computer-Aided Design MH - Equipment Design MH - Equipment Failure Analysis MH - Minimally Invasive Surgical Procedures/*instrumentation MH - Robotics/*instrumentation PMC - PMC4104751 MID - NIHMS334033 EDAT- 2012/01/19 06:00 MHDA- 2012/06/19 06:00 CRDT- 2012/01/19 06:00 PHST- 2012/01/19 06:00 [entrez] PHST- 2012/01/19 06:00 [pubmed] PHST- 2012/06/19 06:00 [medline] AID - 10.1109/IEMBS.2011.6091329 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2011;2011:5372-5. doi: 10.1109/IEMBS.2011.6091329. PMID- 19163406 OWN - NLM STAT- MEDLINE DCOM- 20090428 LR - 20200928 IS - 2375-7477 (Print) IS - 2375-7477 (Linking) VI - 2008 DP - 2008 TI - Highly articulated robotic probe for minimally invasive surgery. PG - 3273-6 LID - 10.1109/IEMBS.2008.4649903 [doi] AB - We have developed a novel highly articulated robotic probe (HARP) that can thread through tightly packed volumes without disturbing the surrounding tissues and organs. We use cardiac surgery as the focal application of this work. As such, we have designed the HARP to enter the pericardial cavity through a subxiphoid port. The surgeon can effectively reach remote intrapericardial locations on the epicardium and deliver therapeutic interventions under direct control. Our device differs from others in that we use conventional actuation and still have great maneuverability. We have performed proof-of-concept clinical experiments to give us preliminary validation of the ideas presented here. FAU - Degani, Amir AU - Degani A AD - Carnegie Mellon University, Pittsburgh, PA 15213, USA. FAU - Choset, Howie AU - Choset H FAU - Zubiate, Brett AU - Zubiate B FAU - Ota, Takeyoshi AU - Ota T FAU - Zenati, Marco AU - Zenati M LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - Animals MH - *Cardiac Surgical Procedures MH - Equipment Design MH - Female MH - Humans MH - Male MH - Minimally Invasive Surgical Procedures/*methods MH - Pericardium/pathology MH - Robotics MH - Surgery, Computer-Assisted/methods MH - Swine EDAT- 2009/01/24 09:00 MHDA- 2009/04/29 09:00 CRDT- 2009/01/24 09:00 PHST- 2009/01/24 09:00 [entrez] PHST- 2009/01/24 09:00 [pubmed] PHST- 2009/04/29 09:00 [medline] AID - 10.1109/IEMBS.2008.4649903 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2008;2008:3273-6. doi: 10.1109/IEMBS.2008.4649903.