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 - AIM 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 SB - T 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 - AIM 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 - AIM 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 - AIM 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 - 20191207 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 - AIM SB - IM MH - *Clinical Competence MH - Cognition/*physiology MH - Humans MH - *Self Report MH - Surgeons/*psychology MH - Workload/*psychology PMC - PMC5878696 MID - NIHMS921855 COIS- Disclosure: The authors declare no conflict of interest. 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 - 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 - AIM 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 - AIM 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 - 20111216 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 - AIM SB - IM 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 - AIM 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 - 20181113 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 - AIM 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 - 20181113 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - AIM 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 - 20171116 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 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 - 20200225 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 - AIM 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 - AIM 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 - 20200928 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. PMID- 20725532 OWN - NLM STAT- Publisher LR - 20191120 IS - 1557-170X (Print) IS - 1557-170X (Linking) VI - 2006 IP - 1642343 DP - 2006 TI - Highly Articulated Robotic Probe for Minimally Invasive Surgery. PG - 4167-4172 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. 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 GR - R01 HL079940/HL/NHLBI NIH HHS/United States GR - R01 HL079940-02/HL/NHLBI NIH HHS/United States GR - R01 HL079940-03/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Conf Proc IEEE Eng Med Biol Soc JT - Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference JID - 101243413 PMC - PMC2923469 MID - NIHMS68485 EDAT- 2006/01/01 00:00 MHDA- 2006/01/01 00:00 CRDT- 2010/08/21 06:00 PHST- 2010/08/21 06:00 [entrez] PHST- 2006/01/01 00:00 [pubmed] PHST- 2006/01/01 00:00 [medline] AID - 10.1109/ROBOT.2006.1642343 [doi] PST - ppublish SO - Conf Proc IEEE Eng Med Biol Soc. 2006;2006(1642343):4167-4172. doi: 10.1109/ROBOT.2006.1642343. PMID- 22255960 OWN - NLM STAT- MEDLINE DCOM- 20120808 LR - 20200928 IS - 2694-0604 (Electronic) IS - 1557-170X (Print) IS - 2375-7477 (Linking) VI - 2011 DP - 2011 TI - Fourier modeling of porcine heartbeat and respiration in vivo for synchronization of HeartLander robot locomotion. PG - 7041-4 LID - 10.1109/IEMBS.2011.6091780 [doi] AB - HeartLander is a small mobile robot which adheres to and navigates over the surface of the heart to provide therapies in a minimally invasive manner. HeartLander's ability to efficiently operate in this dynamic environment is greatly affected by physiological motion, namely the cardiac and respiration cycles. Synchronization of robot motion with minimal intrapericardial pressure results in safer and more efficient travel. The work presented models the physiological components of motion using Fourier series and estimates their parameters using an Extended Kalman Filter. Using the Fourier series parameters, estimates of physiological phase values are calculated to be used for step synchronization. The proposed methods are demonstrated on data from a HeartLander animal study for four locations on the heart. Mean respiration phase estimates are shown to be within 5% of the true respiration phases, while mean cardiac phase estimates are shown to have a minimum error of 11%. FAU - Wood, Nathan A AU - Wood NA AD - Robotics Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA. FAU - Patronik, Nicholas A AU - Patronik NA FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-06/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural 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 - Algorithms MH - Animals MH - Cardiology/instrumentation/methods MH - Equipment Design MH - Fourier Analysis MH - Heart/*physiology MH - Heart Rate MH - Locomotion MH - Models, Statistical MH - Motion MH - Movement/physiology MH - Reproducibility of Results MH - Respiration MH - Robotics/methods MH - Swine PMC - PMC3261510 MID - NIHMS347279 EDAT- 2012/01/19 06:00 MHDA- 2012/08/09 06:00 CRDT- 2012/01/19 06:00 PHST- 2012/01/19 06:00 [entrez] PHST- 2012/01/19 06:00 [pubmed] PHST- 2012/08/09 06:00 [medline] AID - 10.1109/IEMBS.2011.6091780 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2011;2011:7041-4. doi: 10.1109/IEMBS.2011.6091780. PMID- 20179783 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210109 IS - 1552-3098 (Print) IS - 1941-0468 (Electronic) IS - 1552-3098 (Linking) VI - 25 IP - 5 DP - 2009 TI - A Miniature Mobile Robot for Navigation and Positioning on the Beating Heart. PG - 1109-1124 AB - Robotic assistance enhances conventional endoscopy; yet, limitations have hindered its mainstream adoption for cardiac surgery. HeartLander is a miniature mobile robot that addresses several of these limitations by providing precise and stable access over the surface of the beating heart in a less-invasive manner. The robot adheres to the heart and navigates to any desired target in a semiautonomous fashion. The initial therapies considered for HeartLander generally require precise navigation to multiple surface targets for treatment. To balance speed and precision, we decompose any general target acquisition into navigation to the target region followed by fine positioning to each target. In closed-chest, beating-heart animal studies, we demonstrated navigation to targets located around the circumference of the heart, as well as acquisition of target patterns on the anterior and posterior surfaces with an average error of 1.7 mm. The average drift encountered during station-keeping was 0.7 mm. These preclinical results demonstrate the feasibility of precise semiautonomous delivery of therapy to the surface of the beating heart using HeartLander. FAU - Patronik, Nicholas A AU - Patronik NA AD - N. A. Patronik was with the Robotics Institute, Carnegie Mellon University, Pittsburgh, PA 15213 USA. He is now with St. Jude Medical, St. Paul, MN 55117 USA. FAU - Ota, Takeyoshi AU - Ota T FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-03/HL/NHLBI NIH HHS/United States GR - R56 HL078839/HL/NHLBI NIH HHS/United States GR - R56 HL078839-04/HL/NHLBI NIH HHS/United States PT - Journal Article TA - IEEE Trans Robot JT - IEEE transactions on robotics : a publication of the IEEE Robotics and Automation Society JID - 101514509 PMC - PMC2826133 MID - NIHMS176515 EDAT- 2010/02/25 06:00 MHDA- 2010/02/25 06:01 CRDT- 2010/02/25 06:00 PHST- 2010/02/25 06:00 [entrez] PHST- 2010/02/25 06:00 [pubmed] PHST- 2010/02/25 06:01 [medline] AID - 10.1109/tro.2009.2027375 [doi] PST - ppublish SO - IEEE Trans Robot. 2009;25(5):1109-1124. doi: 10.1109/tro.2009.2027375. PMID- 21097014 OWN - NLM STAT- MEDLINE DCOM- 20110329 LR - 20200928 IS - 2375-7477 (Print) IS - 2375-7477 (Linking) VI - 2010 DP - 2010 TI - Evaluation in vitro of a treatment planning algorithm for an epicardial crawling robot. PG - 2275-8 LID - 10.1109/IEMBS.2010.5627690 [doi] AB - HeartLander is a small, mobile robot designed to assist surgical procedures on the surface of the heart. It crawls within the pericardial sac surrounding the heart. Numerous potential clinical uses for HeartLander involve injections or other interventions at multiple locations on the epicardial surface. To minimize treatment time, we have developed an algorithm that optimizes a plan for reaching a given set of treatment targets. Results from in vitro evaluation on a beating heart model show improvement over a greedy technique. FAU - Goyette, Brina E AU - Goyette BE AD - Robotics Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA. FAU - Becker, Brian C AU - Becker BC FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-06/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural 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 - Algorithms MH - Biosensing Techniques MH - Cardiac Surgical Procedures/economics/*instrumentation MH - Equipment Design MH - Heart/physiology MH - Humans MH - In Vitro Techniques MH - Models, Statistical MH - Motion MH - Pericardium/*surgery MH - *Robotics MH - Surgery, Computer-Assisted/economics/*instrumentation MH - Time Factors MH - Treatment Outcome PMC - PMC3136862 MID - NIHMS288821 EDAT- 2010/11/26 06:00 MHDA- 2011/03/30 06:00 CRDT- 2010/11/25 06:00 PHST- 2010/11/25 06:00 [entrez] PHST- 2010/11/26 06:00 [pubmed] PHST- 2011/03/30 06:00 [medline] AID - 10.1109/IEMBS.2010.5627690 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:2275-8. doi: 10.1109/IEMBS.2010.5627690. PMID- 30414248 OWN - NLM STAT- MEDLINE DCOM- 20190610 LR - 20200401 IS - 1478-596X (Electronic) IS - 1478-5951 (Print) IS - 1478-5951 (Linking) VI - 15 IP - 2 DP - 2019 Apr TI - Organ-mounted robot localization via function approximation. PG - e1971 LID - 10.1002/rcs.1971 [doi] AB - BACKGROUND: Organ-mounted robots adhere to the surface of a mobile organ as a platform for minimally invasive interventions, providing passive compensation of physiological motion. This approach is beneficial during surgery on the beating heart. Accurate localization in such applications requires accounting for the heartbeat and respiratory motion. Previous work has described methods for modeling quasi-periodic motion of a point and registering to a static preoperative map. The existing techniques, while accurate, require several respiratory cycles to converge. METHODS: This paper presents a general localization technique for this application, involving function approximation using radial basis function (RBF) interpolation. RESULTS: In an experiment in the porcine model in vivo, the technique yields mean localization accuracy of 1.25 mm with a 95% confidence interval of 0.22 mm. CONCLUSIONS: The RBF approximation provides accurate estimates of robot location instantaneously. CI - © 2018 John Wiley & Sons, Ltd. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania. FAU - Schwartzman, David AU - Schwartzman D AD - Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Passineau, Michael J AU - Passineau MJ AD - Gene Therapy Program, Allegheny Health Network, Pittsburgh, Pennsylvania. FAU - Halbreiner, M Scott AU - Halbreiner MS AUID- ORCID: 0000-0003-1988-0039 AD - Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania. FAU - Moraca, Robert J AU - Moraca RJ AD - Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania. FAU - Zenati, Marco A AU - Zenati MA AD - BHS Department of Cardiothoracic Surgery, Harvard Medical School, West Roxbury, Massachusetts. FAU - Riviere, Cameron N AU - Riviere CN AUID- ORCID: 0000-0002-6749-3140 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 GR - R01HL078839/National Institutes of Health/ GR - R01HL105911/National Institutes of Health/ PT - Journal Article DEP - 20181129 TA - Int J Med Robot JT - The international journal of medical robotics + computer assisted surgery : MRCAS JID - 101250764 SB - IM MH - Animals MH - Robotic Surgical Procedures/*methods MH - Swine PMC - PMC6399018 MID - NIHMS977564 EDAT- 2018/11/11 06:00 MHDA- 2019/06/14 06:00 CRDT- 2018/11/11 06:00 PHST- 2017/07/14 00:00 [received] PHST- 2018/09/14 00:00 [revised] PHST- 2018/09/24 00:00 [accepted] PHST- 2018/11/11 06:00 [pubmed] PHST- 2019/06/14 06:00 [medline] PHST- 2018/11/11 06:00 [entrez] AID - 10.1002/rcs.1971 [doi] PST - ppublish SO - Int J Med Robot. 2019 Apr;15(2):e1971. doi: 10.1002/rcs.1971. Epub 2018 Nov 29. PMID- 29508506 OWN - NLM STAT- MEDLINE DCOM- 20181105 LR - 20181114 IS - 1478-596X (Electronic) IS - 1478-5951 (Print) IS - 1478-5951 (Linking) VI - 14 IP - 4 DP - 2018 Aug TI - Beating-heart registration for organ-mounted robots. PG - e1905 LID - 10.1002/rcs.1905 [doi] AB - BACKGROUND: Organ-mounted robots address the problem of beating-heart surgery by adhering to the heart, passively providing a platform that approaches zero relative motion. Because of the quasi-periodic deformation of the heart due to heartbeat and respiration, registration must address not only spatial registration but also temporal registration. METHODS: Motion data were collected in the porcine model in vivo (N = 6). Fourier series models of heart motion were developed. By comparing registrations generated using an iterative closest-point approach at different phases of respiration, the phase corresponding to minimum registration distance is identified. RESULTS: The spatiotemporal registration technique presented here reduces registration error by an average of 4.2 mm over the 6 trials, in comparison with a more simplistic static registration that merely averages out the physiological motion. CONCLUSIONS: An empirical metric for spatiotemporal registration of organ-mounted robots is defined and demonstrated using data from animal models in vivo. CI - Copyright © 2018 John Wiley & Sons, Ltd. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA. FAU - Schwartzman, David AU - Schwartzman D AD - Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. FAU - Passineau, Michael J AU - Passineau MJ AD - Gene Therapy Program, Allegheny Health Network, Pittsburgh, Pennsylvania, USA. FAU - Moraca, Robert J AU - Moraca RJ AD - Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. FAU - Zenati, Marco A AU - Zenati MA AD - BHS Department of Cardiothoracic Surgery, Harvard Medical School, West Roxbury, Massachusetts, USA. FAU - Riviere, Cameron N AU - Riviere CN AUID- ORCID: 0000-0002-6749-3140 AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA. LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20180306 TA - Int J Med Robot JT - The international journal of medical robotics + computer assisted surgery : MRCAS JID - 101250764 SB - IM MH - Algorithms MH - Animals MH - Cardiac Surgical Procedures/instrumentation/*methods/statistics & numerical data MH - Cardiac-Gated Imaging Techniques MH - Coronary Artery Bypass, Off-Pump/instrumentation/*methods/statistics & numerical data MH - Humans MH - Models, Anatomic MH - Models, Animal MH - Motion MH - Movement MH - Myocardial Contraction MH - Respiration MH - Robotic Surgical Procedures/instrumentation/*methods/statistics & numerical data MH - Swine MH - Tomography, X-Ray Computed PMC - PMC6033680 MID - NIHMS975952 OTO - NOTNLM OT - beating heart OT - cardiac OT - computer-assisted surgery OT - heart OT - imaged-guided surgery OT - minimally invasive surgery OT - model-guided surgery OT - motion compensation OT - organ-mounted robots OT - thoracic respiratory motion EDAT- 2018/03/07 06:00 MHDA- 2018/11/06 06:00 CRDT- 2018/03/07 06:00 PHST- 2017/04/22 00:00 [received] PHST- 2018/01/23 00:00 [revised] PHST- 2018/01/30 00:00 [accepted] PHST- 2018/03/07 06:00 [pubmed] PHST- 2018/11/06 06:00 [medline] PHST- 2018/03/07 06:00 [entrez] AID - 10.1002/rcs.1905 [doi] PST - ppublish SO - Int J Med Robot. 2018 Aug;14(4):e1905. doi: 10.1002/rcs.1905. Epub 2018 Mar 6. PMID- 23366165 OWN - NLM STAT- MEDLINE DCOM- 20130814 LR - 20200928 IS - 2694-0604 (Electronic) IS - 1557-170X (Print) IS - 2375-7477 (Linking) VI - 2012 DP - 2012 TI - Towards localizing on the surface of the beating heart. PG - 1413-6 LID - 10.1109/EMBC.2012.6346204 [doi] AB - This paper presents preliminary work toward localizing on a surface which undergoes periodic deformation, as an aspect of research on HeartLander, a miniature epicardial crawling robot. Using only position measurements from the robot, the aim of this work is to use the nonuniform movements of the heart as features to aid in localization. Using a particle filter, with motion and observation models which accurately model the robotic system, registration and localization parameters can be quickly and accurately identified. The presented framework is demonstrated in simulation on dynamic 2-D models which approximate the deformation of the surface of the heart. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA. fnwood@andrew@rig.cmu.edu FAU - Liu, Tian Yu Tommy AU - Liu TY FAU - Waugh, Kevin AU - Waugh K FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural 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 - Cardiovascular Surgical Procedures/*instrumentation MH - Computer Simulation MH - Heart/physiology MH - Humans MH - Image Processing, Computer-Assisted MH - Miniaturization/instrumentation MH - *Models, Cardiovascular MH - Myocardial Contraction/physiology MH - Robotics/*instrumentation MH - Surgery, Computer-Assisted/*instrumentation PMC - PMC3561935 MID - NIHMS410310 EDAT- 2013/02/01 06:00 MHDA- 2013/08/15 06:00 CRDT- 2013/02/01 06:00 PHST- 2013/02/01 06:00 [entrez] PHST- 2013/02/01 06:00 [pubmed] PHST- 2013/08/15 06:00 [medline] AID - 10.1109/EMBC.2012.6346204 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2012;2012:1413-6. doi: 10.1109/EMBC.2012.6346204. PMID- 22009934 OWN - NLM STAT- MEDLINE DCOM- 20120710 LR - 20181113 IS - 1478-596X (Electronic) IS - 1478-5951 (Print) IS - 1478-5951 (Linking) VI - 8 IP - 1 DP - 2012 Mar TI - Synchronization of epicardial crawling robot with heartbeat and respiration for improved safety and efficiency of locomotion. PG - 97-106 LID - 10.1002/rcs.442 [doi] AB - BACKGROUND: HeartLander is a miniature mobile robot designed to navigate over the epicardium of the beating heart for minimally invasive therapy. This paper presents a technique to decrease slippage and improve locomotion efficiency by synchronizing the locomotion with the intrapericardial pressure variations of the respiration and heartbeat cycles. METHODS: Respiratory and heartbeat phases were detected in real time using a chest-mounted accelerometer during locomotion in a porcine model in vivo. Trials were conducted over the lateral aspect of the heart surface to test synchronized locomotion against an unsynchronized control. RESULTS: Offline evaluation showed that the respiration and heartbeat algorithms had accuracies of 100% and 88%, respectively. Synchronized trials exhibited significantly lower friction, higher efficiency, and greater total distance traveled than control trials. CONCLUSION: Synchronization of the locomotion of HeartLander with respiration and heartbeat is feasible and results in safer and more efficient travel on the beating heart. CI - Copyright © 2011 John Wiley & Sons, Ltd. FAU - Patronik, Nicholas A AU - Patronik NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA 15213, USA. FAU - Ota, Takeyoshi AU - Ota T FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-07/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20111019 TA - Int J Med Robot JT - The international journal of medical robotics + computer assisted surgery : MRCAS JID - 101250764 SB - IM MH - Acceleration MH - Algorithms MH - Animals MH - Equipment Design MH - Heart/*physiology MH - Heart Rate MH - Humans MH - Locomotion MH - Minimally Invasive Surgical Procedures/instrumentation/*methods MH - Pericardium/*pathology MH - Reproducibility of Results MH - Respiration MH - *Robotics MH - Swine PMC - PMC3288233 MID - NIHMS334213 EDAT- 2011/10/20 06:00 MHDA- 2012/07/11 06:00 CRDT- 2011/10/20 06:00 PHST- 2011/09/12 00:00 [accepted] PHST- 2011/10/20 06:00 [entrez] PHST- 2011/10/20 06:00 [pubmed] PHST- 2012/07/11 06:00 [medline] AID - 10.1002/rcs.442 [doi] PST - ppublish SO - Int J Med Robot. 2012 Mar;8(1):97-106. doi: 10.1002/rcs.442. Epub 2011 Oct 19. PMID- 19162640 OWN - NLM STAT- MEDLINE DCOM- 20090507 LR - 20200928 IS - 2375-7477 (Print) IS - 2375-7477 (Linking) VI - 2008 DP - 2008 TI - A novel highly articulated robotic surgical system for epicardial ablation. PG - 250-3 LID - 10.1109/IEMBS.2008.4649137 [doi] AB - We have developed a novel, highly articulated robotic surgical system to enable minimally invasive intrapericardial interventions through a subxiphoid approach and have performed preliminary tests of epicardial left atrial ablation in porcine (N=3) and human cadaver (N=2) preparations. In this study, the novel highly articulated robotic surgical system successfully provided safe epicardial ablations to the left atrium in porcine beating heart models via a subxiphoid approach. We have also performed complex guidance of the robot and subsequent ablation in a cadaveric preparation for successful pulmonary vein isolation. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, The Bioengineering Department, University of Pittsburgh, Pittsburgh, Pennsylvania, 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 - 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 - Cardiovascular Surgical Procedures/*instrumentation/methods MH - Catheter Ablation/*instrumentation/methods MH - Equipment Design MH - Equipment Failure Analysis MH - In Vitro Techniques MH - Pericardium/*anatomy & histology/*surgery MH - Reproducibility of Results MH - Robotics/*instrumentation/methods MH - Sensitivity and Specificity MH - Surgery, Computer-Assisted/*instrumentation/methods MH - Swine MH - User-Computer Interface PMC - PMC2630583 MID - NIHMS67604 EDAT- 2009/01/24 09:00 MHDA- 2009/05/08 09:00 CRDT- 2009/01/24 09:00 PHST- 2009/01/24 09:00 [entrez] PHST- 2009/01/24 09:00 [pubmed] PHST- 2009/05/08 09:00 [medline] AID - 10.1109/IEMBS.2008.4649137 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2008;2008:250-3. doi: 10.1109/IEMBS.2008.4649137. PMID- 17895961 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1559-0879 (Electronic) IS - 1556-9845 (Print) IS - 1556-9845 (Linking) VI - 1 IP - 6 DP - 2006 TI - Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe Via a Percutaneous Subxiphoid Approach. PG - 335-340 AB - OBJECTIVE: Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. METHODS: In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. RESULTS: Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. CONCLUSIONS: We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Degani, Amir AU - Degani A FAU - Zubiate, Brett AU - Zubiate B FAU - Wolf, Alon AU - Wolf A FAU - Choset, Howie AU - Choset H FAU - Schwartzman, David AU - Schwartzman D FAU - Zenati, Marco A AU - Zenati MA LA - eng GR - R01 HL079940/HL/NHLBI NIH HHS/United States GR - R01 HL079940-01A2/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Innovations (Phila) JT - Innovations (Philadelphia, Pa.) JID - 101257528 PMC - PMC1993852 MID - NIHMS24228 EDAT- 2007/09/27 09:00 MHDA- 2007/09/27 09:01 CRDT- 2007/09/27 09:00 PHST- 2007/09/27 09:00 [pubmed] PHST- 2007/09/27 09:01 [medline] PHST- 2007/09/27 09:00 [entrez] AID - 10.1097/imi.0b013e31802f43b1 [doi] PST - ppublish SO - Innovations (Phila). 2006;1(6):335-340. doi: 10.1097/imi.0b013e31802f43b1. PMID- 12454895 OWN - NLM STAT- MEDLINE DCOM- 20030415 LR - 20191210 IS - 1092-9088 (Print) IS - 1092-9088 (Linking) VI - 7 IP - 4 DP - 2002 TI - Experimental off-pump coronary bypass using a robotic telemanipulation system. PG - 248-53 AB - We hypothesized that a high-quality anastomosis between the left internal thoracic artery and the left anterior descending coronary artery could be constructed off-pump using a 4-degrees-of-freedom robotic telemanipulation system, endoscopic myocardial stabilization, and two-dimensional visualization. Nine swine were used. Three ports were created on the left chest for the endoscope and the two robotic arms, and another port was created on the right chest for the endostabilizer. Quality of anastomosis was assessed by angiography, analysis of flow, survival after proximal coronary ligation, and histopathology. All nine anastomoses were completed successfully in 22 +/- 3.6 minutes without the need for repair stitches. Left internal thoracic artery flow was 21.6 +/- 2.5 ml/min with diastolic dominant pattern. Eight animals (89%) survived for 60 minutes with the proximal left anterior descending coronary ligated. Angiographic patency was 100% with Fitzgibbon grade A in all. Histopathology of the anastomosis demonstrated minor changes in the integrity of the endothelium and the internal elastic lamina and absence of medial necrosis. We have demonstrated in our robotic off-pump coronary bypass model that a high-quality anastomosis can be constructed between the left internal thoracic artery and the left anterior descending coronary artery. These results support continued research towards robotic endoscopic off-pump CABG. CI - Copyright 2002 Wiley-Liss, Inc. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA. zenatim@msx.upmc.edu FAU - Nichols, Larry AU - Nichols L FAU - Bonanomi, Gianluca AU - Bonanomi G FAU - Griffith, Bartley P AU - Griffith BP LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Comput Aided Surg JT - Computer aided surgery : official journal of the International Society for Computer Aided Surgery JID - 9708375 SB - IM MH - Anastomosis, Surgical/*standards MH - Animals MH - Cardiopulmonary Bypass MH - Coronary Artery Bypass/*instrumentation/*methods MH - Coronary Vessels/surgery MH - Endoscopy/methods MH - Female MH - Male MH - Mammary Arteries/surgery MH - Models, Animal MH - Robotics/*methods MH - Swine MH - Telemedicine/*methods EDAT- 2002/11/28 04:00 MHDA- 2003/04/16 05:00 CRDT- 2002/11/28 04:00 PHST- 2002/11/28 04:00 [pubmed] PHST- 2003/04/16 05:00 [medline] PHST- 2002/11/28 04:00 [entrez] AID - 10.1002/igs.10045 [doi] PST - ppublish SO - Comput Aided Surg. 2002;7(4):248-53. doi: 10.1002/igs.10045. PMID- 12114129 OWN - NLM STAT- MEDLINE DCOM- 20020912 LR - 20031114 IS - 1098-3511 (Print) IS - 1098-3511 (Linking) VI - 5 IP - 2 DP - 2002 TI - A new live animal training model for off-pump coronary bypass surgery. PG - 150-1 AB - Training models are needed to perform accurate off-pump coronary artery bypass (OPCAB) surgery and to test evolving new technologies like minimally invasive devices and robotics. We describe a simple, effective and reproducible live animal training model to perform multiple arterial anastomoses on the beating heart that would maximize the use of available resources for training purposes. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. zenatim@msx.upmc.edu FAU - Bonanomi, Gianluca AU - Bonanomi G FAU - Kostov, Dean AU - Kostov D FAU - Svanidze, Oleg AU - Svanidze O LA - eng PT - Journal Article PL - United States TA - Heart Surg Forum JT - The heart surgery forum JID - 100891112 SB - IM MH - Anastomosis, Surgical MH - Animals MH - Cardiac Surgical Procedures/*education MH - Clinical Competence MH - Coronary Artery Bypass/*methods MH - *Disease Models, Animal MH - Education, Medical/*methods MH - Models, Anatomic MH - Robotics/methods MH - Swine EDAT- 2002/07/13 10:00 MHDA- 2002/09/13 10:01 CRDT- 2002/07/13 10:00 PHST- 2002/03/13 00:00 [received] PHST- 2002/03/22 00:00 [accepted] PHST- 2002/07/13 10:00 [pubmed] PHST- 2002/09/13 10:01 [medline] PHST- 2002/07/13 10:00 [entrez] PST - ppublish SO - Heart Surg Forum. 2002;5(2):150-1. PMID- 18805144 OWN - NLM STAT- MEDLINE DCOM- 20081022 LR - 20080922 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 86 IP - 4 DP - 2008 Oct TI - Long-term outcome of lung and heart-lung transplantation for idiopathic pulmonary arterial hypertension. PG - 1116-22 LID - 10.1016/j.athoracsur.2008.05.049 [doi] AB - BACKGROUND: The survival after lung and heart-lung transplantation for idiopathic pulmonary arterial hypertension has been reportedly the lowest among the major diagnostic categories of lung transplant recipients. METHODS: Retrospective analysis was performed for lung and heart-lung transplant recipients for idiopathic pulmonary arterial hypertension from 1982 to 2006. The patients were divided into 2 groups, based on the era; group 1: 1982 to 1993, and group 2: 1994 to 2006. Since 1994, we have introduced our current protocols including prostaglandin E1 and nitroglycerin for donor lung preservation, and lung protection with cold and terminal warm blood pneumoplegia as well as immunosuppression with alemtuzumab induction. These modifications were introduced in different years over a wide span of time (1994 to 2003). RESULTS: Group 1 had 59 patients (35 +/- 1 years old, ranging 15 to 53, 20 male and 39 female) with 7 single lung, 11 double lung, and 41 heart-lung, whereas group 2 had 30 (43 +/- 2 years old, ranging 17 to 65, 9 male and 21 female) with 2 single, 20 double, and 8 heart-lung transplantations. The recipient age was significantly (p = 0.004) higher in group 2, and group 2 had significantly older (35 +/- 3 vs 26 +/- 1, p = 0.002) and more female donors (73% vs 41%, p = 0.007) compared with group 1. The actuarial survival was significantly (p = 0.004) better in group 2 with 86% at 1 year, 75% at 5 years, and 66% at 10 years compared with group 1 with 58% at 1 year, 39% at 5 years, and 27% at 10 years. CONCLUSIONS: With our current pulmonary protection and immunosuppression, the long-term outcome of lung and heart-lung transplantation for idiopathic pulmonary arterial hypertension is excellent. FAU - Toyoda, Yoshiya AU - Toyoda Y AD - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. toyoday@upmc.edu FAU - Thacker, Jnanesh AU - Thacker J FAU - Santos, Ricardo AU - Santos R FAU - Nguyen, Duc AU - Nguyen D FAU - Bhama, Jay AU - Bhama J FAU - Bermudez, Christian AU - Bermudez C FAU - Kormos, Robert AU - Kormos R FAU - Johnson, Bruce AU - Johnson B FAU - Crespo, Maria AU - Crespo M FAU - Pilewski, Joseph AU - Pilewski J FAU - Teuteberg, Jeffrey AU - Teuteberg J FAU - Alvarez, Rene AU - Alvarez R FAU - Mathier, Michael AU - Mathier M FAU - McNamara, Dennis AU - McNamara D FAU - McCurry, Kenneth AU - McCurry K FAU - Zenati, Marco AU - Zenati M FAU - Hattler, Brack AU - Hattler B LA - eng PT - Comparative Study PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Adolescent MH - Adult MH - Age Factors MH - Aged MH - Analysis of Variance MH - Cohort Studies MH - Female MH - Follow-Up Studies MH - Graft Rejection MH - Graft Survival MH - Heart-Lung Transplantation/*methods/*mortality MH - Humans MH - Hypertension, Pulmonary/diagnosis/mortality/*surgery MH - Logistic Models MH - Lung Transplantation/methods/mortality MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Postoperative Complications/*mortality MH - Probability MH - Retrospective Studies MH - Risk Assessment MH - Severity of Illness Index MH - Sex Factors MH - Survival Rate MH - Time Factors MH - Treatment Outcome EDAT- 2008/09/23 09:00 MHDA- 2008/10/23 09:00 CRDT- 2008/09/23 09:00 PHST- 2007/08/09 00:00 [received] PHST- 2008/05/15 00:00 [revised] PHST- 2008/05/15 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)01127-2 [pii] AID - 10.1016/j.athoracsur.2008.05.049 [doi] PST - ppublish SO - Ann Thorac Surg. 2008 Oct;86(4):1116-22. doi: 10.1016/j.athoracsur.2008.05.049. PMID- 10543480 OWN - NLM STAT- MEDLINE DCOM- 19991109 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 68 IP - 4 DP - 1999 Oct TI - Transmyocardial laser revascularization in the patient with unmanageable unstable angina. PG - 1203-9 AB - BACKGROUND: Transmyocardial laser revascularization (TMR) provides relief for patients with chronic angina, nonamenable to direct coronary revascularization. Unmanageable, unstable angina (UUA) defines a subset of patients with refractory angina who are at high risk for myocardial infarction and death. Patients were classified in the UUA group when they had been admitted to the critical care unit with unstable angina for 7 days with three failed attempts at weaning them off intravenous antianginal medications. METHODS: Seventy-six treated patients were analyzed to determine if TMR is a viable option for patients with unmanageable unstable angina. These patients were compared with 91 routine protocol patients (protocol group [PG]) undergoing TMR for chronic angina not amenable to standard revascularization. The procedure was performed through a left thoracotomy without cardiopulmonary bypass. These patients were followed for 12 months after the TMR procedure. Both unmanageable and chronic angina patients had a high incidence of at least one prior surgical revascularization (87% and 91%, respectively). RESULTS: Perioperative mortality (< or = 30 days post-TMR) was higher in the UUAG versus PG (16% vs 3%, p = 0.005). Late mortality, up to 1 year of follow-up, was similar (13% vs 11%, UUAG vs PG; p = 0.83). A majority of the adverse events in the UUAG occurred within the first 3 months post-TMR, and patients surviving this interval did well, with reduced angina of at least two classes occurring in 69%, 82%, and 82% of patients at 3, 6, and 12 months, respectively. The percent improvement in angina class from baseline was statistically significant at 3, 6, and 12 months. A comparable improvement in angina was found in the protocol group of patients. CONCLUSIONS: TMR carried a significantly higher risk in unmanageable, unstable angina than in patients with chronic angina. In the later follow-up intervals, however, both groups demonstrated similar and persistent improvement in their angina up to 12 months after the procedure. TMR may be considered in the therapy of patients with unmanageable, unstable angina who otherwise have no recourse to effective therapy in the control of their disabling angina. FAU - Hattler, B G AU - Hattler BG AD - University of Pittsburgh, Pennsylvania 15213, USA. FAU - Griffith, B P AU - Griffith BP FAU - Zenati, M A AU - Zenati MA FAU - Crew, J R AU - Crew JR FAU - Mirhoseini, M AU - Mirhoseini M FAU - Cohn, L H AU - Cohn LH FAU - Aranki, S F AU - Aranki SF FAU - Frazier, O H AU - Frazier OH FAU - Cooley, D A AU - Cooley DA FAU - Lansing, A M AU - Lansing AM FAU - Horvath, K A AU - Horvath KA FAU - Fontana, G P AU - Fontana GP FAU - Landolfo, K P AU - Landolfo KP FAU - Lowe, J E AU - Lowe JE FAU - Boyce, S W AU - Boyce SW LA - eng PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Angina, Unstable/mortality/*surgery MH - Follow-Up Studies MH - Heart Ventricles/*surgery MH - Humans MH - *Laser Therapy MH - Male MH - Middle Aged MH - *Myocardial Revascularization MH - Postoperative Complications/mortality MH - Reoperation MH - Survival Rate MH - Treatment Outcome EDAT- 1999/10/30 00:00 MHDA- 1999/10/30 00:01 CRDT- 1999/10/30 00:00 PHST- 1999/10/30 00:00 [pubmed] PHST- 1999/10/30 00:01 [medline] PHST- 1999/10/30 00:00 [entrez] AID - S0003-4975(99)00972-8 [pii] AID - 10.1016/s0003-4975(99)00972-8 [doi] PST - ppublish SO - Ann Thorac Surg. 1999 Oct;68(4):1203-9. doi: 10.1016/s0003-4975(99)00972-8. PMID- 9436547 OWN - NLM STAT- MEDLINE DCOM- 19980210 LR - 20191211 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 64 IP - 6 DP - 1997 Dec TI - Lung transplantation for respiratory failure resulting from systemic disease. PG - 1630-4 AB - BACKGROUND: Lung transplantation for pulmonary failure resulting from systemic disease is controversial. We reviewed our transplant experience in patients with sarcoidosis, scleroderma, lymphangioleiomyomatosis, and graft-versus-host disease. METHODS: This retrospective review examined the outcome of 23 patients who underwent pulmonary transplantation for these systemic diseases. Group 1 included 15 patients with pulmonary hypertension who underwent transplantation (9 for sarcoidosis, 6 for scleroderma), and group 2 included 8 patients with normal pulmonary artery pressures who underwent transplantation (5 for lymphangioleiomyomatosis, 3 for graft-versus-host disease). The incidences of infection and rejection, pulmonary function, and survival were measured and compared with those of patients who underwent transplantation for isolated pulmonary disease. RESULTS: Although there were no differences in the rate of infection between patients who underwent transplantation for systemic versus isolated disease, patients with pulmonary hypertension who underwent transplantation for systemic disease had significantly lower rates of rejection. Four patients with sarcoidosis and 2 with lymphangioleiomyomatosis demonstrated recurrence in the allograft. Survival was similar between patients who underwent transplantation for systemic versus isolated disease. CONCLUSIONS: Patients with respiratory failure resulting from these systemic diseases can undergo transplantation with outcomes comparable to those obtained in patients who undergo transplantation for isolated pulmonary disease. FAU - Pigula, F A AU - Pigula FA AD - Division of Cardiothoracic Surgery, Presbyterian University Hospital, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. FAU - Griffith, B P AU - Griffith BP FAU - Zenati, M A AU - Zenati MA FAU - Dauber, J H AU - Dauber JH FAU - Yousem, S A AU - Yousem SA FAU - Keenan, R J AU - Keenan RJ LA - eng PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Adult MH - Female MH - Graft Rejection MH - Graft vs Host Disease/complications MH - Humans MH - Hypertension, Pulmonary/complications MH - Immunosuppression/methods MH - Infections/etiology MH - Lung/physiopathology MH - Lung Neoplasms/complications MH - *Lung Transplantation/mortality MH - Lymphangiomyoma/complications MH - Male MH - Postoperative Care/methods MH - Postoperative Complications MH - Recurrence MH - Respiratory Insufficiency/etiology/*surgery MH - Retrospective Studies MH - Sarcoidosis, Pulmonary/complications MH - Scleroderma, Systemic/complications EDAT- 1998/01/22 00:00 MHDA- 1998/01/22 00:01 CRDT- 1998/01/22 00:00 PHST- 1998/01/22 00:00 [pubmed] PHST- 1998/01/22 00:01 [medline] PHST- 1998/01/22 00:00 [entrez] AID - S0003497597009302 [pii] AID - 10.1016/s0003-4975(97)00930-2 [doi] PST - ppublish SO - Ann Thorac Surg. 1997 Dec;64(6):1630-4. doi: 10.1016/s0003-4975(97)00930-2. PMID- 9485247 OWN - NLM STAT- MEDLINE DCOM- 19980313 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 65 IP - 2 DP - 1998 Feb TI - Abciximab and excessive bleeding in patients undergoing emergency cardiac operations. PG - 465-9 AB - BACKGROUND: Abciximab (ReoPro; Eli Lilly and Co, Indianapolis, IN) is a monoclonal antibody that binds to the platelet glycoprotein IIb/IIIa receptor and produces powerful inhibition of platelet function. Clinical trials of abciximab in patients undergoing coronary angioplasty have demonstrated a reduction in thrombotic complications and have encouraged the widespread use of this agent. We have observed a substantial incidence of excessive bleeding among patients who receive abciximab and subsequently require emergency cardiac operations. METHODS: The records of 11 consecutive patients who required emergency cardiac operations after administration of abciximab and failed angioplasty or stent placement were reviewed. RESULTS: The interval from the cessation of abciximab administration to operation was critical in determining the degree of coagulopathy after cardiopulmonary bypass. The median values for postoperative chest drainage (1,300 versus 400 mL; p < 0.01), packed red blood cells transfused (6 versus 0 U; p = 0.02), platelets transfused (20 versus 0 packs; p = 0.02), and maximum activated clotting time (800 versus 528 seconds; p = 0.01) all were significantly greater in the early group (cardiac operation < 12 hours after abciximab administration; n = 6) compared with the late (cardiac operation >12 hours after abciximab administration; n = 5) group. CONCLUSIONS: This report suggests that the antiplatelet agent abciximab is associated with substantial bleeding when it is administered within 12 hours of operation. FAU - Gammie, J S AU - Gammie JS AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. gam@med.pitt.edu FAU - Zenati, M AU - Zenati M FAU - Kormos, R L AU - Kormos RL FAU - Hattler, B G AU - Hattler BG FAU - Wei, L M AU - Wei LM FAU - Pellegrini, R V AU - Pellegrini RV FAU - Griffith, B P AU - Griffith BP FAU - Dyke, C M AU - Dyke CM LA - eng PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R RN - 0 (Antibodies, Monoclonal) RN - 0 (Immunoglobulin Fab Fragments) RN - 0 (Platelet Aggregation Inhibitors) RN - X85G7936GV (Abciximab) SB - AIM SB - IM CIN - Ann Thorac Surg. 1999 Jan;67(1):292-3. PMID: 10086586 MH - Abciximab MH - Adult MH - Aged MH - Antibodies, Monoclonal/administration & dosage/*adverse effects MH - *Blood Loss, Surgical MH - *Cardiac Surgical Procedures MH - *Emergency Treatment MH - Female MH - Humans MH - Immunoglobulin Fab Fragments/administration & dosage/*adverse effects MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/administration & dosage/*adverse effects MH - Postoperative Hemorrhage/*chemically induced EDAT- 1998/03/04 00:00 MHDA- 1998/03/04 00:01 CRDT- 1998/03/04 00:00 PHST- 1998/03/04 00:00 [pubmed] PHST- 1998/03/04 00:01 [medline] PHST- 1998/03/04 00:00 [entrez] AID - S0003-4975(97)01299-X [pii] AID - 10.1016/s0003-4975(97)01299-x [doi] PST - ppublish SO - Ann Thorac Surg. 1998 Feb;65(2):465-9. doi: 10.1016/s0003-4975(97)01299-x. PMID- 2620535 OWN - NLM STAT- MEDLINE DCOM- 19900320 LR - 20031114 IS - 0149-7944 (Print) IS - 0149-7944 (Linking) VI - 46 IP - 6 DP - 1989 Nov-Dec TI - Experimental donor-transmitted pneumonia in a model of canine orthotopic unilateral lung allotransplantation. PG - 464-7 FAU - Dowling, R D AU - Dowling RD FAU - Zenati, M AU - Zenati M FAU - Pasculle, A W AU - Pasculle AW FAU - Yousem, S A AU - Yousem SA FAU - Griffith, B P AU - Griffith BP FAU - Hardesty, R L AU - Hardesty RL LA - eng PT - Journal Article PL - United States TA - Curr Surg JT - Current surgery JID - 7802123 SB - IM MH - Animals MH - Dogs MH - Female MH - Lung/*microbiology MH - *Lung Transplantation MH - Pneumonia, Pneumococcal/*transmission MH - Streptococcus pneumoniae MH - *Tissue Donors MH - Transplantation, Homologous EDAT- 1989/11/01 00:00 MHDA- 1989/11/01 00:01 CRDT- 1989/11/01 00:00 PHST- 1989/11/01 00:00 [pubmed] PHST- 1989/11/01 00:01 [medline] PHST- 1989/11/01 00:00 [entrez] PST - ppublish SO - Curr Surg. 1989 Nov-Dec;46(6):464-7. PMID- 20868842 OWN - NLM STAT- MEDLINE DCOM- 20101021 LR - 20100927 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 90 IP - 4 DP - 2010 Oct TI - Severe functional mitral regurgitation arising from isolated annular dilatation. PG - 1343-5 LID - 10.1016/j.athoracsur.2010.03.026 [doi] AB - Functional mitral regurgitation or functional tricuspid regurgitation most commonly result from maladaptive remodeling due to ischemic heart disease or idiopathic dilatative cardiomyopathy. We report a case of significant functional mitral regurgitation and functional tricuspid regurgitation arising from isolated annular dilatation secondary to atrial fibrillation and associated atrial remodeling. The patient underwent successful mitral and tricuspid valve repair and a bi-atrial Maze procedure. CI - Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Kilic, Arman AU - Kilic A AD - Division of Cardiac Surgery, Heart, Lung, and Esophageal Surgery Institute, Pittsburgh, Pennsylvania, USA. FAU - Schwartzman, David S AU - Schwartzman DS FAU - Subramaniam, Kathirvel AU - Subramaniam K 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 - AIM SB - IM MH - Atrial Fibrillation/*complications/surgery MH - Catheter Ablation MH - Dilatation, Pathologic MH - Heart Atria MH - Heart Valve Prosthesis Implantation MH - Humans MH - Male MH - Middle Aged MH - Mitral Valve MH - Mitral Valve Insufficiency/etiology/*physiopathology MH - Tricuspid Valve Insufficiency/etiology/*physiopathology EDAT- 2010/09/28 06:00 MHDA- 2010/10/22 06:00 CRDT- 2010/09/28 06:00 PHST- 2010/02/25 00:00 [received] PHST- 2010/03/12 00:00 [revised] PHST- 2010/03/17 00:00 [accepted] PHST- 2010/09/28 06:00 [entrez] PHST- 2010/09/28 06:00 [pubmed] PHST- 2010/10/22 06:00 [medline] AID - S0003-4975(10)00635-1 [pii] AID - 10.1016/j.athoracsur.2010.03.026 [doi] PST - ppublish SO - Ann Thorac Surg. 2010 Oct;90(4):1343-5. doi: 10.1016/j.athoracsur.2010.03.026. PMID- 14521663 OWN - NLM STAT- MEDLINE DCOM- 20040413 LR - 20191210 IS - 1045-3873 (Print) IS - 1045-3873 (Linking) VI - 14 IP - 10 DP - 2003 Oct TI - Epicardium-based left atrial ablation: impact on electromechanical properties. PG - 1087-92 AB - Epicardium-Based LA Ablation. INTRODUCTION: An important developmental task for surgical ablation of atrial fibrillation is simplification. A significant step would be the development of tools that create satisfactory ablation lesions without necessitating cardiopulmonary bypass or atriotomy. Optimally, these lesions would have no adverse impact on atrial electromechanical properties. METHODS AND RESULTS: We sought to characterize left atrial (LA) lesions created by a bipolar ablation device without cardiopulmonary bypass or atriotomy and to assess their impact on LA electromechanical properties. In each of five pigs, lesions were delivered to the epicardium of the beating heart, and encircled and connected right and left pulmonary vein vestibules and the atrial appendage. Before and after ablation, LA electromechanical properties were assessed using endocardial electromechanical mapping and intracardiac echocardiography. Postmortem histologic analysis also was performed. Each lesion was thrombus-free and barotrauma-free, histologically transmural, and a complete conduction barrier. Although a large aggregate area (24% +/- 6%) of LA myocardium was excluded, there was no significant change in global electromechanical properties. However, marked diminishment in appendage function was observed. CONCLUSION: Epicardium-based LA ablation in a beating heart could be achieved successfully without cardiopulmonary bypass or atriotomy. Although there was no adverse impact on global electromechanical properties, there was evidence of important regional diminishment. FAU - Schwartzman, David AU - Schwartzman D AD - Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, PA, USA. schwartzmand@msx.upmc.edu FAU - Bonanomi, Gianluca AU - Bonanomi G FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Cardiovasc Electrophysiol JT - Journal of cardiovascular electrophysiology JID - 9010756 SB - IM MH - Animals MH - Atrial Function, Left/*physiology MH - Body Surface Potential Mapping/*methods MH - Catheter Ablation/*methods MH - Female MH - Heart Atria/cytology/*surgery MH - Male MH - Myocardial Contraction/physiology MH - Pericardium/cytology/*physiology/*surgery MH - Pulmonary Veins/cytology/*physiology/*surgery MH - Swine EDAT- 2003/10/03 05:00 MHDA- 2004/04/14 05:00 CRDT- 2003/10/03 05:00 PHST- 2003/10/03 05:00 [pubmed] PHST- 2004/04/14 05:00 [medline] PHST- 2003/10/03 05:00 [entrez] AID - 03230 [pii] AID - 10.1046/j.1540-8167.2003.03230.x [doi] PST - ppublish SO - J Cardiovasc Electrophysiol. 2003 Oct;14(10):1087-92. doi: 10.1046/j.1540-8167.2003.03230.x. PMID- 11250326 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1557-3117 (Electronic) IS - 1053-2498 (Linking) VI - 20 IP - 2 DP - 2001 Feb TI - Ten year experience of FK 506 for adult cardiac transplantation at a single institution. PG - 191-192 FAU - Sakai, T AU - Sakai T AD - University of Pittsburgh, Pittsburgh, PA, USA FAU - Kormos, R L AU - Kormos RL FAU - Mccurry, K R AU - Mccurry KR FAU - Ristich, J AU - Ristich J FAU - Hattler, B G AU - Hattler BG FAU - Zenati, M AU - Zenati M FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 EDAT- 2001/03/16 10:00 MHDA- 2001/03/16 10:01 CRDT- 2001/03/16 10:00 PHST- 2001/03/16 10:00 [pubmed] PHST- 2001/03/16 10:01 [medline] PHST- 2001/03/16 10:00 [entrez] AID - S1053-2498(00)00400-9 [pii] AID - 10.1016/s1053-2498(00)00400-9 [doi] PST - ppublish SO - J Heart Lung Transplant. 2001 Feb;20(2):191-192. doi: 10.1016/s1053-2498(00)00400-9. PMID- 30815055 OWN - NLM STAT- MEDLINE DCOM- 20190927 LR - 20200320 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) VI - 2018 DP - 2018 TI - Process Driven Guidance for Complex Surgical Procedures. PG - 175-184 AB - Surgical team processes are known to be complex and error prone. This paper describes an approach that uses a detailed, validated model of a medical process to provide the clinicians who carry out that complex process with offline and online guidance to help reduce errors. Offline guidance is in the form of a hypertext document describing all the ways the process can be carried out. Online guidance is in the form of a context-sensitive and continually updated electronic "checklist" that lists next steps and needed resources, as well as completed steps. In earlier work, we focused on providing such guidance for single-clinician or single-team processes. This paper describes guiding the collaboration of multiple teams of clinicians through complex processes with significant concurrency, complicated exception handling, and precise and timely communication. We illustrate this approach by applying it to a highly complex, high risk subprocess of cardiac surgery. FAU - Avrunin, George S AU - Avrunin GS AD - University of Massachusetts, Amherst, MA, USA. FAU - Christov, Stefan C AU - Christov SC AD - Quinnipiac University, Hamden, CT, USA. FAU - Clarke, Lori A AU - Clarke LA AD - University of Massachusetts, Amherst, MA, USA. FAU - Conboy, Heather M AU - Conboy HM AD - University of Massachusetts, Amherst, MA, USA. FAU - Osterweil, Leon J AU - Osterweil LJ AD - University of Massachusetts, Amherst, MA, USA. FAU - Zenati, Marco A AU - Zenati MA AD - Harvard Medical School, Boston, MA, USA. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20181205 TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings. AMIA Symposium JID - 101209213 SB - IM MH - *Cardiac Surgical Procedures MH - *Checklist MH - Communication MH - Humans MH - Medical Errors/prevention & control MH - Medical Records Systems, Computerized MH - Models, Organizational MH - Operating Rooms/organization & administration MH - Surgery, Computer-Assisted PMC - PMC6371362 EDAT- 2019/03/01 06:00 MHDA- 2019/09/29 06:00 CRDT- 2019/03/01 06:00 PHST- 2019/03/01 06:00 [entrez] PHST- 2019/03/01 06:00 [pubmed] PHST- 2019/09/29 06:00 [medline] AID - 2977076 [pii] PST - epublish SO - AMIA Annu Symp Proc. 2018 Dec 5;2018:175-184. eCollection 2018. PMID- 12570963 OWN - NLM STAT- MEDLINE DCOM- 20030321 LR - 20190708 IS - 0735-1097 (Print) IS - 0735-1097 (Linking) VI - 41 IP - 1 DP - 2003 Jan 1 TI - Left atrial appendectomy and maze. PG - 170; author reply 170-1 FAU - Bonanomi, Gianluca AU - Bonanomi G FAU - Zenati, Marco A AU - Zenati MA FAU - Schwartzman, David AU - Schwartzman D LA - eng PT - Comment PT - Letter PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 RN - 0 (Anticoagulants) RN - 5Q7ZVV76EI (Warfarin) SB - AIM SB - IM CON - J Am Coll Cardiol. 2002 Aug 7;40(3):475-80. PMID: 12142113 MH - Anticoagulants/therapeutic use MH - Atrial Fibrillation/complications/*drug therapy/*surgery MH - Cardiac Surgical Procedures/*methods MH - Heart Atria/*surgery MH - Humans MH - Intracranial Embolism/etiology/*prevention & control MH - Stroke/etiology/*prevention & control MH - Treatment Outcome MH - Warfarin/therapeutic use EDAT- 2003/02/07 04:00 MHDA- 2003/03/22 04:00 CRDT- 2003/02/07 04:00 PHST- 2003/02/07 04:00 [pubmed] PHST- 2003/03/22 04:00 [medline] PHST- 2003/02/07 04:00 [entrez] AID - S0735109702026712 [pii] AID - 10.1016/s0735-1097(02)02671-2 [doi] PST - ppublish SO - J Am Coll Cardiol. 2003 Jan 1;41(1):170; author reply 170-1. doi: 10.1016/s0735-1097(02)02671-2. PMID- 30417737 OWN - NLM STAT- MEDLINE DCOM- 20190116 LR - 20190116 IS - 1533-4406 (Electronic) IS - 0028-4793 (Linking) VI - 380 IP - 2 DP - 2019 Jan 10 TI - Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass. PG - 132-141 LID - 10.1056/NEJMoa1812390 [doi] AB - BACKGROUND: The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS: We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS: A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarctions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS: Among patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082 .). FAU - Zenati, Marco A AU - Zenati MA AUID- ORCID: 0000-0001-7139-0323 AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Bhatt, Deepak L AU - Bhatt DL AUID- ORCID: 0000-0002-1278-6245 AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Bakaeen, Faisal G AU - Bakaeen FG AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Stock, Eileen M AU - Stock EM AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Biswas, Kousick AU - Biswas K AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Gaziano, J Michael AU - Gaziano JM AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Kelly, Rosemary F AU - Kelly RF AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Tseng, Elaine E AU - Tseng EE AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Bitondo, Jerene AU - Bitondo J AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Quin, Jacquelyn A AU - Quin JA AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Almassi, G Hossein AU - Almassi GH AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Haime, Miguel AU - Haime M AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Hattler, Brack AU - Hattler B AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - DeMatt, Ellen AU - DeMatt E AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Scrymgeour, Alexandra AU - Scrymgeour A AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). FAU - Huang, Grant D AU - Huang GD AD - From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) - all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). CN - REGROUP Trial Investigators LA - eng SI - ClinicalTrials.gov/NCT01850082 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20181111 PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM CIN - Nat Rev Cardiol. 2019 Jan;16(1):3. PMID: 30487544 CIN - N Engl J Med. 2019 Jan 10;380(2):189-191. PMID: 30625061 CIN - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141649 CIN - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141650 CIN - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141651 CIN - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141652 CIN - J Thorac Dis. 2019 May;11(Suppl 9):S1342-S1345. PMID: 31245128 MH - Aged MH - Coronary Artery Bypass/*methods MH - *Endoscopy MH - Female MH - Follow-Up Studies MH - Heart Diseases/mortality/*surgery MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/epidemiology MH - Reoperation/statistics & numerical data MH - Saphenous Vein/surgery/*transplantation MH - Surgical Wound Infection/etiology MH - Tissue and Organ Harvesting/adverse effects/*methods MH - Vascular Surgical Procedures/adverse effects/methods FIR - Colling, Cindy IR - Colling C FIR - Gabany, Jennifer M IR - Gabany JM FIR - Ardehali, Abbas IR - Ardehali A FIR - Ebrahimi, Ramin IR - Ebrahimi R FIR - Ferraris, Victor IR - Ferraris V FIR - Ramadan, Ronnie IR - Ramadan R FIR - MacCallum, Gail IR - MacCallum G FIR - Wolfe, Hill IR - Wolfe H FIR - Phillips, Annette IR - Phillips A FIR - Point, Perry IR - Point P FIR - Beam, Michael IR - Beam M FIR - Briones, Daniel IR - Briones D FIR - Collins, Joseph IR - Collins J FIR - Dalzell, Christine IR - Dalzell C FIR - Kim, Jeanie IR - Kim J FIR - Wiseman, Annette IR - Wiseman A FIR - O’Leary, Timothy J IR - O’Leary TJ FIR - Jessen, Michael IR - Jessen M FIR - Blackwelder, William IR - Blackwelder W FIR - Burdon, Thomas IR - Burdon T FIR - Harrell, Frank IR - Harrell F FIR - Mariconda, Dominick IR - Mariconda D FIR - Wu, Wen-Chih Hank IR - Wu WCH FIR - Yassin, Said IR - Yassin S FIR - Bernabei, Alvise IR - Bernabei A FIR - Rode, Richard IR - Rode R FIR - Bates, Edward IR - Bates E FIR - Geuss, Micah IR - Geuss M FIR - Lucke, John IR - Lucke J FIR - Ferguson, Robert IR - Ferguson R FIR - Hill, Ronald IR - Hill R FIR - Ballard, Paul IR - Ballard P FIR - Nicolini, Michael IR - Nicolini M FIR - Coyle, Mariette IR - Coyle M FIR - Allen, Valerie IR - Allen V FIR - Sprinkle, Whitney IR - Sprinkle W FIR - Quin, Jacquelyn IR - Quin J FIR - Taylor, Kristin IR - Taylor K FIR - Bullinga, Linda IR - Bullinga L FIR - Cmolik, Brian IR - Cmolik B FIR - Rubelowsky, Joseph IR - Rubelowsky J FIR - Hanson, Gregory IR - Hanson G FIR - Eiseman, Matthew IR - Eiseman M FIR - Smith, Peter IR - Smith P FIR - Gaca, Jeffery IR - Gaca J FIR - Daneshnard, Mani IR - Daneshnard M FIR - Schroder, Jacob IR - Schroder J FIR - Harvey, John IR - Harvey J FIR - Hurley, Kista IR - Hurley K FIR - Edelestein, Scott IR - Edelestein S FIR - Perna, Jennifer IR - Perna J FIR - Wagner, Melissa IR - Wagner M FIR - Welsh, Stacey IR - Welsh S FIR - Marshall, Donna IR - Marshall D FIR - Stinson, Wade IR - Stinson W FIR - Staples, Edward IR - Staples E FIR - Mixon, Rebecca IR - Mixon R FIR - Allen, Courtney IR - Allen C FIR - Irwin, Anne IR - Irwin A FIR - Bakaeen, Faisal IR - Bakaeen F FIR - Omer, Shuab IR - Omer S FIR - Cornwell, Lorraine IR - Cornwell L FIR - Jimenez, Ernesto IR - Jimenez E FIR - Riffel, Anthony IR - Riffel A FIR - Delgado, Antonio IR - Delgado A FIR - Swann, James IR - Swann J FIR - Boudreaux, Cynthia IR - Boudreaux C FIR - Chee, Adrienne IR - Chee A FIR - Grossi, Eugene IR - Grossi E FIR - DeAnda, Abelardo IR - DeAnda A FIR - Culliford, Alfred IR - Culliford A FIR - DeRosa, Michael IR - DeRosa M FIR - Gogoladze, George IR - Gogoladze G FIR - Karas, Tomer IR - Karas T FIR - Vejdani, Bethaney IR - Vejdani B FIR - Miriello, Daisy IR - Miriello D FIR - Quintero, Jalima IR - Quintero J FIR - Rashid, Zahir IR - Rashid Z FIR - Thorson, Susan IR - Thorson S FIR - Garnas, Mark IR - Garnas M FIR - Smith, Brittany IR - Smith B FIR - Schubert, Carla IR - Schubert C FIR - Pecsi, Sharon IR - Pecsi S FIR - McFalls, Edward IR - McFalls E FIR - Ward, Herbert IR - Ward H FIR - Shumway, Sara IR - Shumway S FIR - Loor, Gabriel IR - Loor G FIR - Marsh, Bonnie IR - Marsh B FIR - Breutzman, Gayle IR - Breutzman G FIR - Thompson, Katie IR - Thompson K FIR - Meyeraan, Tacy IR - Meyeraan T FIR - Johnson, Debra IR - Johnson D FIR - Chu, Daniel IR - Chu D FIR - Miller, Timothy IR - Miller T FIR - Skwortz, Regina IR - Skwortz R FIR - Ravichandran, Pasala IR - Ravichandran P FIR - Raitt, Merritt IR - Raitt M FIR - Willenborg, Catherine IR - Willenborg C FIR - Ruimy, Daniel IR - Ruimy D FIR - Burman, Melody IR - Burman M FIR - Dana, Karina IR - Dana K FIR - Strasser, Denise IR - Strasser D FIR - Subramanian, Sandhya IR - Subramanian S FIR - Tanaka, Michael IR - Tanaka M FIR - Wozniak, Curt IR - Wozniak C FIR - Julien, Matheau IR - Julien M FIR - Pribyl, Shea IR - Pribyl S FIR - Hintz, Douglas IR - Hintz D FIR - Valera, Augusto IR - Valera A FIR - Wrights, Dionne IR - Wrights D FIR - Stanley, Kathleen IR - Stanley K FIR - Casson, Lucinda IR - Casson L FIR - Krogstad, Marya IR - Krogstad M FIR - Sastry, Narendra IR - Sastry N FIR - Lopez, Carmen IR - Lopez C FIR - Sebastian, Nicy IR - Sebastian N FIR - Hoy, Brenda IR - Hoy B FIR - Nisbet, Julie IR - Nisbet J FIR - Fernandez, Ileana IR - Fernandez I FIR - Gutierrez, Carmen IR - Gutierrez C FIR - Goldman, Steven IR - Goldman S FIR - Rhenman, Birger IR - Rhenman B FIR - Kapoor, Divya IR - Kapoor D FIR - Keller, Roy IR - Keller R FIR - Morgan, Amani IR - Morgan A FIR - Lambeth, Barbara IR - Lambeth B EDAT- 2018/11/13 06:00 MHDA- 2019/01/17 06:00 CRDT- 2018/11/13 06:00 PHST- 2018/11/13 06:00 [pubmed] PHST- 2019/01/17 06:00 [medline] PHST- 2018/11/13 06:00 [entrez] AID - 10.1056/NEJMoa1812390 [doi] PST - ppublish SO - N Engl J Med. 2019 Jan 10;380(2):132-141. doi: 10.1056/NEJMoa1812390. Epub 2018 Nov 11. PMID- 11827862 OWN - NLM STAT- MEDLINE DCOM- 20020322 LR - 20141120 IS - 1098-3511 (Print) IS - 1098-3511 (Linking) VI - 4 IP - 4 DP - 2001 TI - Hybrid strategies in minimally invasive revascularization. PG - 328-30 FAU - Zenati, M A AU - Zenati MA AD - Minimally Invasive Cardiac Surgery and Robotics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. zenatim@msx.upmc.edu LA - eng PT - Journal Article PL - United States TA - Heart Surg Forum JT - The heart surgery forum JID - 100891112 SB - IM MH - Coronary Disease/economics/surgery MH - Humans MH - Mammary Arteries/surgery MH - *Minimally Invasive Surgical Procedures/economics MH - *Myocardial Revascularization/economics MH - Treatment Outcome EDAT- 2002/02/06 10:00 MHDA- 2002/03/23 10:01 CRDT- 2002/02/06 10:00 PHST- 2002/02/06 10:00 [pubmed] PHST- 2002/03/23 10:01 [medline] PHST- 2002/02/06 10:00 [entrez] PST - ppublish SO - Heart Surg Forum. 2001;4(4):328-30. PMID- 11726428 OWN - NLM STAT- MEDLINE DCOM- 20011213 LR - 20190704 IS - 0003-2999 (Print) IS - 0003-2999 (Linking) VI - 93 IP - 6 DP - 2001 Dec TI - Minimally invasive direct coronary artery bypass surgery under high thoracic epidural. PG - 1486-8, table of contents AB - This report describes the use of high-thoracic epidural anesthesia for a patient undergoing minimally invasive direct coronary artery bypass. FAU - Paiste, J AU - Paiste J AD - Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, PA 15240, USA. jupst8@imap.pitt.edu FAU - Bjerke, R J AU - Bjerke RJ FAU - Williams, J P AU - Williams JP FAU - Zenati, M A AU - Zenati MA FAU - Nagy, G E AU - Nagy GE LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 SB - AIM SB - IM MH - *Anesthesia, Epidural MH - *Coronary Artery Bypass/methods MH - Humans MH - Male MH - Middle Aged MH - *Minimally Invasive Surgical Procedures EDAT- 2001/12/01 10:00 MHDA- 2002/01/05 10:01 CRDT- 2001/12/01 10:00 PHST- 2001/12/01 10:00 [pubmed] PHST- 2002/01/05 10:01 [medline] PHST- 2001/12/01 10:00 [entrez] AID - 10.1097/00000539-200112000-00028 [doi] PST - ppublish SO - Anesth Analg. 2001 Dec;93(6):1486-8, table of contents. doi: 10.1097/00000539-200112000-00028. PMID- 10047645 OWN - NLM STAT- MEDLINE DCOM- 19990318 LR - 20190915 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 117 IP - 3 DP - 1999 Mar TI - Alternative approach to multivessel coronary disease with integrated coronary revascularization. PG - 439-44; discussion 444-6 AB - OBJECTIVE: Integrated coronary revascularization combines minimally invasive coronary artery bypass grafting (MICABG) with left internal thoracic artery-left anterior descending artery grafting and percutaneous coronary intervention. We hypothesized that integrated coronary revascularization could result in successful revascularization in suitable patients with multivessel coronary artery disease. METHODS: Between September 1996 and January 1998, 31 consecutive patients underwent integrated coronary revascularization. Twenty-two were male; mean age was 69 years (46-86 years) and 42% were older than 75 years. Eight patients (26%) had a Parsonnet score greater than 20%. Left ventricular ejection fraction was 46.3% +/- 12%; 6 patients (19%) had a left ventricular ejection fraction less than 35%. RESULTS: The anastomosis time for MICABG with the internal thoracic artery was 14.6 +/- 5.2 minutes and the operating time was 105 +/- 20 minutes; 28 patients (90%) were extubated in the operating room. The internal thoracic artery anastomosis was patent in all 31 patients (100%). Percutaneous coronary intervention was performed before MICABG in 2 patients (7%), on the same day of MICABG in 16 patients (52%), on postoperative day 1 in 3 patients (9%), and on postoperative days 2 to 4 in 10 patients (32%). Postprocedure length of stay in the hospital was 2.7 +/- 1.0 days and 13 patients (42%) were discharged home on postoperative day 1 or 2. Three patients (9.6%) required repeat target vessel revascularization in the distribution of the previous percutaneous coronary intervention. All patients are alive without angina at a follow-up of 10.8 +/- 3.8 months. CONCLUSION: Our early results demonstrate that integrated coronary revascularization can be performed safely and effectively. Long-term results will be available from a prospective randomized trial now underway to compare integrated coronary revascularization with coronary artery bypass grafting for multivessel coronary artery disease. FAU - Zenati, M AU - Zenati M AD - Divisions of Cardiothoracic Surgery and Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. FAU - Cohen, H A AU - Cohen HA 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 - AIM SB - IM CIN - J Thorac Cardiovasc Surg. 1999 Oct;118(4):766-7. PMID: 10504652 CIN - J Thorac Cardiovasc Surg. 1999 Nov;118(5):977-8. PMID: 10534716 MH - Aged MH - Aged, 80 and over MH - Angioplasty, Balloon, Coronary MH - Coronary Artery Bypass/methods MH - Coronary Disease/surgery MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Minimally Invasive Surgical Procedures MH - Myocardial Revascularization/*methods MH - Postoperative Complications MH - Retreatment MH - Thoracic Arteries/surgery EDAT- 1999/02/27 03:14 MHDA- 2000/03/04 09:00 CRDT- 1999/02/27 03:14 PHST- 1999/02/27 03:14 [pubmed] PHST- 2000/03/04 09:00 [medline] PHST- 1999/02/27 03:14 [entrez] AID - S0022522399000331 [pii] AID - 10.1016/s0022-5223(99)70322-3 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 1999 Mar;117(3):439-44; discussion 444-6. doi: 10.1016/s0022-5223(99)70322-3. PMID- 9814788 OWN - NLM STAT- MEDLINE DCOM- 19990119 LR - 20190512 IS - 1010-7940 (Print) IS - 1010-7940 (Linking) VI - 14 Suppl 1 DP - 1998 Oct TI - MIDCAB characteristics and results: the CardioThoracic Systems (CTS) registry. PG - S25-30 AB - OBJECTIVE: The CardioThoracic Systems (CTS) registry of minimally invasive direct coronary artery bypass (MIDCAB) was established to examine baseline characteristics of patients undergoing this surgical procedure, document details of the procedures including grafting techniques and post-operative complication rates, and assess post-operative graft patency. METHODS: A total of 508 consecutive patients who had MIDCAB using CTS instrumentation between April 1996 and March 1997 at 35 international centers were analyzed. RESULTS: The mean age of patients, 27% of whom were women, was 63 years. Eight percent had previous coronary artery bypass surgery. While nearly all patients had significant stenoses in the left anterior descending artery, 23% had disease in two vessels and 9% in three vessels. Almost all procedures used the left internal mammary artery, with 7% employing multiple or sequential grafts. The entire surgical procedure lasted on average 135 min (median 2 h), with a mean time of 14 min to perform anastomosis. Surgical approaches, including anastomosis technique and method used to maintain bloodless field, varied widely across clinical centers. In-hospital complication rates were relatively low, with 0.6% mortality (0% perioperative), 1.2% conversion to sternotomy with cardiopulmonary bypass, 1.4% conversion to sternotomy without bypass, and 5.5% redo or reintervention. In total, 92% of patients were free from all of these events at hospital discharge; women showed a strong trend toward increased risk for major in-hospital events compared with men. Rib fracture was the most common complication, reported in 12% of patients. Post-operative angiography, performed in 83 patients at an average 2.2 days post-procedure, found full patency in 78 (94%). CONCLUSIONS: The CTS registry data indicates that in the great majority of patients, MIDCAB using CTS instrumentation was performed safely and with acute success. Comparative studies, most importantly clinical trials, are needed to determine the types of patients who benefit most from this procedure, as well as its longer-term outcome. FAU - Holubkov, R AU - Holubkov R AD - Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA. holubkov@edc.gsph.pitt.edu FAU - Zenati, M AU - Zenati M FAU - Akin, J J AU - Akin JJ FAU - Erb, L AU - Erb L FAU - Courcoulas, A AU - Courcoulas A LA - eng PT - Journal Article PT - Multicenter Study PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Coronary Artery Bypass/instrumentation/methods/*statistics & numerical data MH - Female MH - Humans MH - Internal Mammary-Coronary Artery Anastomosis/instrumentation/methods/statistics & numerical data MH - Male MH - Middle Aged MH - Minimally Invasive Surgical Procedures/instrumentation/methods/statistics & numerical data MH - Postoperative Complications/epidemiology MH - Registries/*statistics & numerical data MH - Time Factors MH - Treatment Outcome MH - Vascular Patency EDAT- 1998/11/14 00:00 MHDA- 1998/11/14 00:01 CRDT- 1998/11/14 00:00 PHST- 1998/11/14 00:00 [pubmed] PHST- 1998/11/14 00:01 [medline] PHST- 1998/11/14 00:00 [entrez] AID - 10.1016/s1010-7940(98)00100-6 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S25-30. doi: 10.1016/s1010-7940(98)00100-6. PMID- 9736589 OWN - NLM STAT- MEDLINE DCOM- 19981001 LR - 20190623 IS - 0009-7322 (Print) IS - 0009-7322 (Linking) VI - 98 IP - 11 DP - 1998 Sep 15 TI - Feasibility of combined percutaneous transluminal angioplasty and minimally invasive direct coronary artery bypass in patients with multivessel coronary artery disease. PG - 1048-50 AB - BACKGROUND: Angioplasty has become an accepted treatment of patients with coronary artery disease and is now commonly used to treat patients with multivessel disease. The major disadvantage of angioplasty has been restenosis requiring repeat interventions with resultant loss of initial cost savings. Compared with the right and the circumflex coronary arteries, the left anterior descending artery (LAD) has been more adversely affected by restenosis. Recently, minimally invasive direct coronary artery bypass (MIDCAB) to the LAD through a small left anterior thoracotomy using the left internal mammary artery has been performed in some centers with excellent early results and with reduced costs compared with standard bypass surgery. METHODS AND RESULTS: We retrospectively reviewed the first 31 consecutive patients treated in our institution with integrated coronary revascularization (ICR): MIDCAB to the LAD combined with PTCA of the other diseased vessels in patients with multivessel disease. Postoperative angiography in 84% of patients revealed a patent anastomosis and normal flow in the graft and bypassed vessel. Thirty-eight (97%) of 39 vessels were successfully treated percutaneously. At a mean follow-up of 7 months, all patients are currently asymptomatic. There have been 2 adverse clinical events, both related to angioplasty and not to MIDCAB. The average length of stay at the hospital after MIDCAB was 2.79+/-1.05 days. CONCLUSIONS: These preliminary results with ICR are encouraging and suggest that a randomized, prospective clinical trial comparing ICR with standard coronary artery bypass surgery for the revascularization of symptomatic patients with multivessel disease involving the LAD is warranted. FAU - Cohen, H A AU - Cohen HA AD - From the Divisions of Cardiology and Cardiovascular Surgery, The University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA 15213, USA. cohenha@msx.upmc.edu FAU - Zenati, M AU - Zenati M FAU - Smith, A J AU - Smith AJ FAU - Lee, J S AU - Lee JS FAU - Chough, S AU - Chough S FAU - Jafar, Z AU - Jafar Z FAU - Counihan, P AU - Counihan P FAU - Izzo, M AU - Izzo M FAU - Burchenal, J E AU - Burchenal JE FAU - Feldman, A M AU - Feldman AM FAU - Griffith, B AU - Griffith B LA - eng PT - Journal Article PL - United States TA - Circulation JT - Circulation JID - 0147763 SB - AIM SB - IM MH - *Angioplasty, Balloon, Coronary MH - Coronary Artery Bypass/*methods MH - Coronary Disease/*surgery/*therapy MH - Coronary Vessels MH - Humans MH - Minimally Invasive Surgical Procedures/*methods MH - Retrospective Studies MH - Stents MH - Treatment Outcome EDAT- 1998/09/16 00:00 MHDA- 1998/09/16 00:01 CRDT- 1998/09/16 00:00 PHST- 1998/09/16 00:00 [pubmed] PHST- 1998/09/16 00:01 [medline] PHST- 1998/09/16 00:00 [entrez] AID - 10.1161/01.cir.98.11.1048 [doi] PST - ppublish SO - Circulation. 1998 Sep 15;98(11):1048-50. doi: 10.1161/01.cir.98.11.1048. PMID- 9203606 OWN - NLM STAT- MEDLINE DCOM- 19970717 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 63 IP - 6 Suppl DP - 1997 Jun TI - Resource utilization for minimally invasive direct and standard coronary artery bypass grafting. PG - S84-7 AB - BACKGROUND: Minimally invasive direct coronary artery bypass grafting (MIDCABG) has been recently reintroduced into the cardiac surgical armamentarium for selected patients with suitable coronary anatomy. We hypothesized that MIDCABG had the potential for similar immediate results with decreased perioperative morbidity and decreased resource utilization compared with standard coronary artery bypass grafting (CABG). METHODS: From January 1996 to August 1996, 17 MIDCABG patients were compared with 33 patients with left ventricular ejection fraction greater than 0.50 who underwent CABG with standard technique. No significant differences were observed between the two groups for preoperative variables that are known to affect cost and resource utilization. Length of stay in the hospital was 2.5 +/- 0.8 days for MIDCABG and 5.9 +/- 2 days for CABG (p < 0.0001); length of stay in the intensive care unit was 12.3 +/- 3.3 hours for MIDCABG compared to 32.3 +/- 12.6 hours for the CABG group (p < 0.0001). RESULTS: Forty-one percent of MIDCABG patients were extubated in the operating room and 59% were discharged home on the first or second postoperative day versus none in the CABG group (p < 0.0001). Significantly less morbidity was observed in the MIDCABG group compared with CABG. Total ratio of cost-to-charge was $12,885 +/- $1,511 for MIDCABG and $21,260 +/- $5,497 for CABG (p < 0.0001), with an average savings of $8,375. CONCLUSIONS: Minimally invasive CABG is associated with significant reduction of resource utilization and morbidity related to inital hospitalization compared with CABG. FAU - Zenati, M AU - Zenati M AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania 15213-2582, USA. zenati@pittsurg.nb.upmc.edu FAU - Domit, T M AU - Domit TM FAU - Saul, M AU - Saul M FAU - Gorcsan, J 3rd AU - Gorcsan J 3rd FAU - Katz, W E AU - Katz WE FAU - Hudson, M AU - Hudson M FAU - Courcoulas, A P AU - Courcoulas AP FAU - Griffith, B P AU - Griffith BP LA - eng PT - Comparative Study PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Aged MH - Blood Transfusion/statistics & numerical data MH - *Coronary Artery Bypass/adverse effects/economics/methods MH - Female MH - Health Care Costs MH - Health Resources/*statistics & numerical data MH - Humans MH - Intensive Care Units/statistics & numerical data MH - Length of Stay MH - Male MH - Middle Aged MH - *Minimally Invasive Surgical Procedures/adverse effects/economics MH - Stroke Volume EDAT- 1997/06/01 00:00 MHDA- 2001/03/28 10:01 CRDT- 1997/06/01 00:00 PHST- 1997/06/01 00:00 [pubmed] PHST- 2001/03/28 10:01 [medline] PHST- 1997/06/01 00:00 [entrez] AID - S0003-4975(97)00324-X [pii] AID - 10.1016/s0003-4975(97)00324-x [doi] PST - ppublish SO - Ann Thorac Surg. 1997 Jun;63(6 Suppl):S84-7. doi: 10.1016/s0003-4975(97)00324-x. PMID- 17946816 OWN - NLM STAT- MEDLINE DCOM- 20080306 LR - 20200609 IS - 1557-170X (Print) IS - 1557-170X (Linking) VI - 2006 DP - 2006 TI - Improved traction for a mobile robot traveling on the heart. PG - 339-42 AB - This document describes the effects of several design parameters on the traction generated by the suction pads of a mobile robot that walks on the surface of the heart. HeartLander is a miniature mobile robot that adheres to the epicardial surface of the heart using suction, and can travel to any desired location on the heart to administer therapeutic applications. To maximize the effectiveness of locomotion, the gripper pads must provide sufficient traction to avoid slipping. Our testing setup measured the force applied to the gripper pad adhering to ovine epicardial tissue, and recorded overhead video for tracking of the pad and tissue during an extension. By synchronizing the force and video data, we were able to determine the point at which the pad lost traction and slipped during the extension. Of the pads tested, the pad with no suction grate achieved maximum traction. Increasing the extension speed up to 20 mm/s resulted in a corresponding increase in traction. Increasing the vacuum pressure also improved the traction, but the magnitude of the effect was less than the improvement gained from increasing extension speed. FAU - Patronik, N A AU - Patronik NA AD - Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA. FAU - Ota, T AU - Ota T FAU - Zenati, M A AU - Zenati MA FAU - Riviere, C N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States PT - Evaluation Study PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Conf Proc IEEE Eng Med Biol Soc JT - Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference JID - 101243413 SB - IM MH - Animals MH - Cardiovascular Surgical Procedures/*instrumentation/methods MH - Equipment Design MH - Equipment Failure Analysis MH - Friction MH - Minimally Invasive Surgical Procedures/*instrumentation/methods MH - Motion MH - Pericardium/*physiology/*surgery MH - Robotics/*instrumentation/methods MH - Sheep EDAT- 2007/10/20 09:00 MHDA- 2008/03/07 09:00 CRDT- 2007/10/20 09:00 PHST- 2007/10/20 09:00 [pubmed] PHST- 2008/03/07 09:00 [medline] PHST- 2007/10/20 09:00 [entrez] AID - 10.1109/IEMBS.2006.259532 [doi] PST - ppublish SO - Conf Proc IEEE Eng Med Biol Soc. 2006;2006:339-42. doi: 10.1109/IEMBS.2006.259532. PMID- 18036952 OWN - NLM STAT- MEDLINE DCOM- 20071213 LR - 20071126 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 84 IP - 6 DP - 2007 Dec TI - Epicardial left ventricular mapping using subxiphoid video pericardioscopy. PG - 2106-7 AB - We report a novel subxiphoid video pericardioscopy approach for epicardial mapping that allows direct visualization of the epicardium with minimal use of fluoroscopy. The FLEXview system (Boston Scientific Cardiac Surgery, Santa Clara, CA), which is capable of a free navigation around the heart owing to its flexible neck, was inserted into the pericardial space through a small subxiphoid incision. A commercially available mapping catheter advanced through the working port of the device could be navigated around virtually the entire biventricular epicardial surface. The subxiphoid video pericardioscopy approach using the FLEXview system provided adequate visualization and access to the epicardium of both ventricles for electroanatomic mapping while minimizing surgical invasiveness. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. zenatim@upmc.edu FAU - Shalaby, Alaa AU - Shalaby A FAU - Eisenman, Gregory AU - Eisenman G FAU - Nosbisch, John AU - Nosbisch J FAU - McGarvey, Jeremy AU - McGarvey J FAU - Ota, Takeyoshi AU - Ota T LA - eng PT - Case Reports PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Body Surface Potential Mapping/*methods MH - Catheter Ablation/*methods MH - *Endoscopy MH - Humans MH - Male MH - Middle Aged MH - Pericardium/*pathology MH - Tachycardia, Ventricular/diagnosis/physiopathology/*surgery MH - Xiphoid Bone EDAT- 2007/11/27 09:00 MHDA- 2007/12/14 09:00 CRDT- 2007/11/27 09:00 PHST- 2007/03/28 00:00 [received] PHST- 2007/05/16 00:00 [revised] PHST- 2007/07/09 00:00 [accepted] PHST- 2007/11/27 09:00 [pubmed] PHST- 2007/12/14 09:00 [medline] PHST- 2007/11/27 09:00 [entrez] AID - S0003-4975(07)01555-X [pii] AID - 10.1016/j.athoracsur.2007.07.032 [doi] PST - ppublish SO - Ann Thorac Surg. 2007 Dec;84(6):2106-7. doi: 10.1016/j.athoracsur.2007.07.032. PMID- 16393791 OWN - NLM STAT- MEDLINE DCOM- 20060713 LR - 20141120 IS - 1092-9088 (Print) IS - 1092-9088 (Linking) VI - 10 IP - 4 DP - 2005 Jul TI - Preliminary evaluation of a mobile robotic device for navigation and intervention on the beating heart. PG - 225-32 AB - This article describes the development and preliminary testing of a mobile robotic device to facilitate minimally invasive beating-heart intrapericardial intervention. The HeartLander robot will be introduced beneath the pericardium via subxiphoid incision, adhere to the epicardium, navigate to any location, and administer therapy under the control of the physician. As compared to current robotic cardiac surgical techniques, this novel paradigm obviates immobilization of the heart and eliminates access limitations. Furthermore, it does not require lung deflation and differential ventilation and thus could enable outpatient cardiac surgery. The current HeartLander prototypes use suction to maintain prehension of the epicardium and wire actuation to perform locomotion. A fiber optic videoscope displays visual feedback to the physician, who controls the device through a joystick interface. The initial prototype demonstrated successful prehension, turning, and locomotion on open-chest, beating-heart porcine models where the pericardium was removed (N = 3). A smaller second-generation prototype with an injection system demonstrated locomotion and myocardial injection of dye, both performed with the pericardium intact (N = 3). These trials illustrate the feasibility of using a miniature mobile robot to navigate upon the beating heart and perform intrapericardial therapy. FAU - Patronik, N A AU - Patronik NA AD - The Robotics Institute, Carnegie Mellon University, Pennsylvania 15213, USA. FAU - Zenati, M A AU - Zenati MA FAU - Riviere, C N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - Comput Aided Surg JT - Computer aided surgery : official journal of the International Society for Computer Aided Surgery JID - 9708375 SB - IM MH - Animals MH - Cardiac Surgical Procedures/*instrumentation MH - Equipment Design MH - *Laparoscopes MH - Minimally Invasive Surgical Procedures/*instrumentation MH - Pericardium/*surgery MH - Robotics/*instrumentation MH - Swine MH - Video-Assisted Surgery/*instrumentation EDAT- 2006/01/06 09:00 MHDA- 2006/07/14 09:00 CRDT- 2006/01/06 09:00 PHST- 2006/01/06 09:00 [pubmed] PHST- 2006/07/14 09:00 [medline] PHST- 2006/01/06 09:00 [entrez] AID - N126Q6346482322M [pii] AID - 10.3109/10929080500230197 [doi] PST - ppublish SO - Comput Aided Surg. 2005 Jul;10(4):225-32. doi: 10.3109/10929080500230197. PMID- 31141653 OWN - NLM STAT- MEDLINE DCOM- 20190531 LR - 20210109 IS - 1533-4406 (Electronic) IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 380 IP - 22 DP - 2019 May 30 TI - Endoscopic versus Open Vein-Graft Harvesting for CABG. Reply. PG - e43 LID - 10.1056/NEJMc1904533#sa5 [pii] LID - 10.1056/NEJMc1904533 [doi] FAU - Zenati, Marco A AU - Zenati MA AD - Veterans Affairs Boston Healthcare System, Boston, MA marco_zenati@hms.harvard.edu. FAU - Bhatt, Deepak L AU - Bhatt DL AD - Brigham and Women's Hospital Heart and Vascular Center, Boston, MA. FAU - Stock, Eileen M AU - Stock EM AD - Cooperative Studies Program Coordinating Center, Perry Point, MD. LA - eng GR - 588/ImVA/Intramural VA/United States PT - Comment PT - Letter TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM CON - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141649 CON - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141650 CON - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141651 CON - N Engl J Med. 2019 May 30;380(22):e43. PMID: 31141652 MH - Coronary Artery Bypass MH - *Endoscopy MH - *Tissue and Organ Harvesting PMC - PMC7297290 MID - NIHMS1587187 COIS- Since publication of their article, the authors report no further potential conflict of interest. EDAT- 2019/05/30 06:00 MHDA- 2019/06/01 06:00 CRDT- 2019/05/30 06:00 PHST- 2019/05/30 06:00 [entrez] PHST- 2019/05/30 06:00 [pubmed] PHST- 2019/06/01 06:00 [medline] AID - 10.1056/NEJMc1904533#sa5 [pii] AID - 10.1056/NEJMc1904533 [doi] PST - ppublish SO - N Engl J Med. 2019 May 30;380(22):e43. doi: 10.1056/NEJMc1904533. PMID- 15041933 OWN - NLM STAT- MEDLINE DCOM- 20040520 LR - 20161124 IS - 0021-9509 (Print) IS - 0021-9509 (Linking) VI - 45 IP - 1 DP - 2004 Feb TI - Emergent off-pump complete myocardial revascularization in dextrocardia. PG - 31-3 AB - Dextrocardia is a rare condition not spared by coronary artery disease. We report the case of a 72-year-old patient with dextrocardia associated with situs inversus totalis who presented to our Institution with acute myocardial infarction complicated by congestive heart failure. Due to the severe general conditions of the patient, an emergent off-pump complete myocardial revascularization was undertaken. The patient tolerated the procedure well and was asymptomatic at discharge. The technical aspects encountered in the setting of mirror-image anatomy and the advantages of off-pump myocardial revascularization in the critically ill patient are discussed. FAU - Bonanomi, G AU - Bonanomi G AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. FAU - Kostov, D AU - Kostov D FAU - Zenati, M A AU - Zenati MA LA - eng PT - Case Reports PT - Journal Article PL - Italy TA - J Cardiovasc Surg (Torino) JT - The Journal of cardiovascular surgery JID - 0066127 SB - IM MH - Acute Disease MH - Aged MH - Angioplasty, Balloon, Coronary MH - Cardiac Catheterization MH - Cardiopulmonary Bypass MH - Coronary Artery Bypass/*methods MH - Coronary Disease/diagnosis/*etiology/physiopathology/*surgery MH - Dextrocardia/*complications/diagnostic imaging MH - Echocardiography MH - Electrocardiography MH - Emergencies MH - Female MH - Heart Failure/diagnosis/etiology MH - Hepatitis C, Chronic/etiology MH - Humans MH - Hyperparathyroidism, Secondary/etiology MH - Hypertension/etiology MH - Kidney Failure, Chronic/etiology MH - Myocardial Infarction/diagnosis/*etiology/*surgery MH - Radiography MH - Saphenous Vein/transplantation MH - Situs Inversus/*complications/diagnostic imaging MH - Stroke Volume MH - Treatment Outcome MH - Ventricular Dysfunction, Left/etiology EDAT- 2004/03/26 05:00 MHDA- 2004/05/21 05:00 CRDT- 2004/03/26 05:00 PHST- 2004/03/26 05:00 [pubmed] PHST- 2004/05/21 05:00 [medline] PHST- 2004/03/26 05:00 [entrez] PST - ppublish SO - J Cardiovasc Surg (Torino). 2004 Feb;45(1):31-3. PMID- 22866058 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 1680-0737 (Print) IS - 1680-0737 (Linking) VI - 37 IP - Part 1, Part 3 DP - 2012 TI - A Study Ex Vivo of the Effect of Epicardial Fat on the HeartLander Robotic Crawler. PG - 227-230 AB - A tethered epicardial crawling robot known as HeartLander has been developed for minimally-invasive surgery on the beating heart. The crawler has been tested in vivo many times in a porcine model, a model which provides generally authentic conditions in many ways; however, the pigs tested generally have little epicardial fat, whereas the epicardial fat in human patients will be considerable. As a result, it is necessary to determine the effect of such fat on the performance of the crawler. In one experiment, using fresh ovine hearts ex vivo, clogging of the suction chambers of the crawler during sliding over tissue with active suction was investigated for a variety of thicknesses of epicardial fat. In a second experiment, the maximum traction force during each step was measured when sliding with active suction repeatedly over the same location for a variety of fat thicknesses. The clogging experiment showed accumulation of fat in the suction chamber, with the amount dependent on the state of the epicardial membrane, but the suction line did not clog. The traction experiment showed that traction was maintained in all cases except when the epicardial membrane was excised completely. FAU - Patronik, N A AU - Patronik NA AD - Atrial Fibrillation Division, St. Jude Medical, New Brighton, MN, USA. FAU - Zenati, M A AU - Zenati MA FAU - Riviere, C N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-06/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States GR - R01 HL105911-01/HL/NHLBI NIH HHS/United States PT - Journal Article TA - IFMBE Proc JT - IFMBE proceedings JID - 101270746 PMC - PMC3410713 MID - NIHMS347278 EDAT- 2012/08/07 06:00 MHDA- 2012/08/07 06:01 CRDT- 2012/08/07 06:00 PHST- 2012/08/07 06:00 [entrez] PHST- 2012/08/07 06:00 [pubmed] PHST- 2012/08/07 06:01 [medline] AID - 10.1007/978-3-642-23508-5_60 [doi] PST - ppublish SO - IFMBE Proc. 2012;37(Part 1, Part 3):227-230. doi: 10.1007/978-3-642-23508-5_60. PMID- 21126639 OWN - NLM STAT- MEDLINE DCOM- 20110208 LR - 20170203 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 56 IP - 24 DP - 2010 Dec 7 TI - Outcomes of the RESTOR-MV Trial (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). PG - 1984-93 LID - 10.1016/j.jacc.2010.06.051 [doi] AB - OBJECTIVES: we sought to determine whether patients with functional mitral regurgitation (FMR) would benefit from ventricular reshaping by the Coapsys device (Myocor, Inc., Maple Grove, Minnesota). BACKGROUND: FMR occurs when ventricular remodeling impairs valve function. Coapsys is a ventricular shape change device placed without cardiopulmonary bypass to reduce FMR. It compresses the mitral annulus and reshapes the ventricle. We hypothesized that Coapsys for FMR would improve clinical outcomes compared with standard therapies. METHODS: RESTOR-MV (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve) was a randomized, prospective, multicenter study of patients with FMR and coronary disease with core laboratory analysis. After enrollment, patients were stratified to the standard indicated surgery: either coronary artery bypass graft alone or coronary artery bypass graft with mitral valve repair. In each stratum, randomization was to either control (indicated surgery) or treatment (coronary artery bypass graft with Coapsys ventricular reshaping). RESULTS: the study was terminated when the sponsor failed to secure ongoing funding; 165 patients were randomized. Control and Coapsys both produced decreases in left ventricular (LV) end-diastolic dimension and MR at 2 years (p < 0.001); Coapsys provided a greater decrease in LV end-diastolic dimension (p = 0.021). Control had lower MR grades during follow-up (p = 0.01). Coapsys showed a survival advantage compared with control at 2 years (87% vs. 77%) (hazard ratio: 0.421; 95% confidence interval: 0.200 to 0.886; stratified log-rank test; p = 0.038). Complication-free survival (including death, stroke, myocardial infarction, and valve reoperation) was significantly greater with Coapsys at 2 years (85% vs. 71%) (hazard ratio: 0.372; 95% confidence interval: 0.185 to 0.749; adjusted log-rank test; p = 0.019). CONCLUSIONS: analysis of RESTOR-MV indicates that patients with FMR requiring revascularization treated with ventricular reshaping rather than standard surgery had improved survival and a significant decrease in major adverse outcomes. This trial validates the concept of the ventricular reshaping strategy in this subset of patients with heart failure. (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve [RESTOR-MV]; NCT00120276). CI - Published by Elsevier Inc. All rights reserved. FAU - Grossi, Eugene A AU - Grossi EA AD - New York University School of Medicine and New York Harbor Veterans Healthcare System, New York, New York 10028, USA. grossi@cv.med.nyu.edu FAU - Patel, Nirav AU - Patel N FAU - Woo, Y Joseph AU - Woo YJ FAU - Goldberg, Judith D AU - Goldberg JD FAU - Schwartz, Charles F AU - Schwartz CF FAU - Subramanian, Valavanur AU - Subramanian V FAU - Feldman, Ted AU - Feldman T FAU - Bourge, Robert AU - Bourge R FAU - Baumgartner, Norbert AU - Baumgartner N FAU - Genco, Christopher AU - Genco C FAU - Goldman, Scott AU - Goldman S FAU - Zenati, Marco AU - Zenati M FAU - Wolfe, J Alan AU - Wolfe JA FAU - Mishra, Yugal K AU - Mishra YK FAU - Trehan, Naresh AU - Trehan N FAU - Mittal, Sanjay AU - Mittal S FAU - Shang, Shulian AU - Shang S FAU - Mortier, Todd J AU - Mortier TJ FAU - Schweich, Cyril J Jr AU - Schweich CJ Jr CN - RESTOR-MV Study Group LA - eng SI - ClinicalTrials.gov/NCT00120276 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - AIM SB - IM MH - Aged MH - Female MH - Follow-Up Studies MH - *Heart Ventricles MH - *Heart-Assist Devices MH - Humans MH - Male MH - Middle Aged MH - Mitral Valve Insufficiency/*surgery MH - Treatment Outcome EDAT- 2010/12/04 06:00 MHDA- 2011/02/09 06:00 CRDT- 2010/12/04 06:00 PHST- 2009/10/05 00:00 [received] PHST- 2010/04/15 00:00 [revised] PHST- 2010/06/16 00:00 [accepted] PHST- 2010/12/04 06:00 [entrez] PHST- 2010/12/04 06:00 [pubmed] PHST- 2011/02/09 06:00 [medline] AID - S0735-1097(10)04192-6 [pii] AID - 10.1016/j.jacc.2010.06.051 [doi] PST - ppublish SO - J Am Coll Cardiol. 2010 Dec 7;56(24):1984-93. doi: 10.1016/j.jacc.2010.06.051. PMID- 22447466 OWN - NLM STAT- MEDLINE DCOM- 20120710 LR - 20120419 IS - 1531-4995 (Electronic) IS - 0023-852X (Linking) VI - 122 IP - 5 DP - 2012 May TI - A transoral highly flexible robot: Novel technology and application. PG - 1067-71 LID - 10.1002/lary.23237 [doi] AB - OBJECTIVES/HYPOTHESIS: Organ preservation surgery is a major focus in head and neck oncology. Current approaches are aimed toward improving quality of life and decreasing treatment-related morbidity. Transoral robotic surgery was developed to overcome the limitations of traditional surgical approaches. The most widely used robotic system is the da Vinci Surgical System. Although the da Vinci offers clear surgical advantages over traditional approaches, its rigid operative arms prevent complex maneuverability in three-dimensional space. The ideal surgical robot would configure to the anatomy of the patient and maneuver in narrow spaces. We present the first cadaveric trials of the use of a highly flexible robot able to traverse the nonlinear upper aerodigestive tract and gain physical and visual access to important anatomical landmarks without laryngeal suspension. STUDY DESIGN: Feasibility. METHODS: Using human cadavers, we investigated the feasibility of visualizing the endolarynx transorally with a highly flexible robot without performing suspension of the larynx. Two fresh and four preserved human specimens were used. RESULTS: Unhampered visualization of the endolarynx was achieved in all specimens without performing laryngeal suspension. Standard mouth retractors facilitated the delivery of the robot into the endolarynx. CONCLUSIONS: The flexible robot technology mitigates laryngeal suspension and the limitations of current robotic surgery with rigid line-of-sight-directed instruments. Having demonstrated the feasibility of physical and visual access to the endolarynx, future work will study the feasibility of using the highly flexible robot in transoral robotic procedures with flexible instrumentation placed in the robot's available working ports. CI - Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc. FAU - Rivera-Serrano, Carlos M AU - Rivera-Serrano CM AD - Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. FAU - Johnson, Paul AU - Johnson P FAU - Zubiate, Brett AU - Zubiate B FAU - Kuenzler, Richard AU - Kuenzler R FAU - Choset, Howie AU - Choset H FAU - Zenati, Marco AU - Zenati M FAU - Tully, Stephen AU - Tully S FAU - Duvvuri, Umamaheswar AU - Duvvuri U LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20120323 PL - United States TA - Laryngoscope JT - The Laryngoscope JID - 8607378 SB - IM MH - Adult MH - Cadaver MH - Equipment Design MH - Feasibility Studies MH - Humans MH - Larynx/*surgery MH - Microsurgery/instrumentation MH - Mouth MH - Otorhinolaryngologic Surgical Procedures/*methods MH - Robotics/*instrumentation EDAT- 2012/03/27 06:00 MHDA- 2012/07/11 06:00 CRDT- 2012/03/27 06:00 PHST- 2011/09/28 00:00 [received] PHST- 2011/12/27 00:00 [revised] PHST- 2012/01/17 00:00 [accepted] PHST- 2012/03/27 06:00 [entrez] PHST- 2012/03/27 06:00 [pubmed] PHST- 2012/07/11 06:00 [medline] AID - 10.1002/lary.23237 [doi] PST - ppublish SO - Laryngoscope. 2012 May;122(5):1067-71. doi: 10.1002/lary.23237. Epub 2012 Mar 23. PMID- 21278000 OWN - NLM STAT- MEDLINE DCOM- 20111129 LR - 20161222 IS - 1556-3871 (Electronic) IS - 1547-5271 (Linking) VI - 8 IP - 6 DP - 2011 Jun TI - Conservative management of pericardial-esophageal fistula complicating robotic atrial fibrillation ablation. PG - 905-8 LID - 10.1016/j.hrthm.2011.01.035 [doi] FAU - Shalaby, Alaa AU - Shalaby A AD - Division of Cardiology, University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. Alaa.Shalaby@va.gov FAU - Refaat, Marwan AU - Refaat M FAU - Sebastien, Gilbert AU - Sebastien G FAU - Zenati, Marco AU - Zenati M LA - eng PT - Case Reports PT - Journal Article DEP - 20110126 PL - United States TA - Heart Rhythm JT - Heart rhythm JID - 101200317 SB - IM MH - Adult MH - Atrial Fibrillation/surgery MH - Catheter Ablation/*adverse effects/methods MH - Drainage/*methods MH - Esophageal Fistula/diagnosis/etiology/*therapy MH - Esophagoscopy/*methods MH - Fistula/diagnosis/etiology/*therapy MH - Heart Diseases/diagnosis/etiology/*therapy MH - Humans MH - Male MH - Pericardium MH - *Robotics MH - Tomography, X-Ray Computed EDAT- 2011/02/01 06:00 MHDA- 2011/12/13 00:00 CRDT- 2011/02/01 06:00 PHST- 2010/12/30 00:00 [received] PHST- 2011/01/20 00:00 [accepted] PHST- 2011/02/01 06:00 [entrez] PHST- 2011/02/01 06:00 [pubmed] PHST- 2011/12/13 00:00 [medline] AID - S1547-5271(11)00073-7 [pii] AID - 10.1016/j.hrthm.2011.01.035 [doi] PST - ppublish SO - Heart Rhythm. 2011 Jun;8(6):905-8. doi: 10.1016/j.hrthm.2011.01.035. Epub 2011 Jan 26. PMID- 18973508 OWN - NLM STAT- MEDLINE DCOM- 20090525 LR - 20181113 IS - 1540-8183 (Electronic) IS - 0896-4327 (Print) IS - 0896-4327 (Linking) VI - 21 IP - 6 DP - 2008 Dec TI - Feasibility of myxomatous mitral valve repair using direct leaflet and chordal radiofrequency ablation. PG - 547-54 LID - 10.1111/j.1540-8183.2008.00398.x [doi] AB - OBJECTIVE: Minimally invasive repair of mitral valve prolapse (MVP) causing severe mitral regurgitation (MR) should reduce MR and have chronic durability. Our ex vivo, acute in vivo, and chronic in vivo studies suggest that direct application of radiofrequency ablation (RFA) to mitral leaflets and chordae can effect these repair goals to decrease MR. METHODS: A total of seven canines were studied to assess the effects of RFA on mitral valve structure and function. RFA was applied ex vivo (n = 1), acutely in vivo using a right lateral thoracotomy and cardiopulmonary bypass (n = 3), and chronically in vivo using percutaneous access to the heart (n = 3). RFA was applied to the mitral valve and its associated chordae. Mitral valve structure and function (in vivo preparations) were then assessed. RESULTS: Ex vivo application of RFA resulted in qualitative reduction in mitral leaflet surface area and chordal length. Acute in vivo application of RFA to canines found to have MVP causing severe MR demonstrated a 43.7-60.7% statistically significant (P = 0.039) reduction in postablation MR. Chronic, in vivo, percutaneous application of RFA was found to be feasible and the engendered alterations durable. CONCLUSION: These data suggest that myxomatous mitral valve repair using radiofrequency energy delivered via catheter is feasible. FAU - Williams, Jeffrey L AU - Williams JL AD - Good Samaritan Health System, Lebanon Cardiology Associates, Lebanon, Pennsylvania 17042, USA. lcaep@hotmail.com FAU - Toyoda, Yoshiya AU - Toyoda Y FAU - Ota, Takeyoshi AU - Ota T FAU - Gutkin, Dmitry AU - Gutkin D FAU - Katz, William AU - Katz W FAU - Zenati, Marco AU - Zenati M FAU - Schwartzman, David AU - Schwartzman D LA - eng GR - L30 HL085922-01/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20081021 TA - J Interv Cardiol JT - Journal of interventional cardiology JID - 8907826 SB - IM MH - Animals MH - Catheter Ablation/*methods MH - Disease Models, Animal MH - Dogs MH - Echocardiography MH - Mitral Valve Insufficiency/diagnostic imaging/etiology/*therapy MH - Mitral Valve Prolapse/diagnostic imaging/physiopathology/*therapy MH - Pennsylvania MH - Treatment Outcome PMC - PMC2602795 MID - NIHMS80795 EDAT- 2008/11/01 09:00 MHDA- 2009/05/26 09:00 CRDT- 2008/11/01 09:00 PHST- 2008/11/01 09:00 [pubmed] PHST- 2009/05/26 09:00 [medline] PHST- 2008/11/01 09:00 [entrez] AID - JOIC398 [pii] AID - 10.1111/j.1540-8183.2008.00398.x [doi] PST - ppublish SO - J Interv Cardiol. 2008 Dec;21(6):547-54. doi: 10.1111/j.1540-8183.2008.00398.x. Epub 2008 Oct 21. PMID- 26736239 OWN - NLM STAT- MEDLINE DCOM- 20161011 LR - 20200928 IS - 2694-0604 (Electronic) IS - 1557-170X (Print) IS - 2375-7477 (Linking) VI - 2015 DP - 2015 TI - An artificial system for selecting the optimal surgical team. PG - 218-21 LID - 10.1109/EMBC.2015.7318339 [doi] AB - We introduce an intelligent system to optimize a team composition based on the team's historical outcomes and apply this system to compose a surgical team. The system relies on a record of the procedures performed in the past. The optimal team composition is the one with the lowest probability of unfavorable outcome. We use the theory of probability and the inclusion exclusion principle to model the probability of team outcome for a given composition. A probability value is assigned to each person of database and the probability of a team composition is calculated from them. The model allows to determine the probability of all possible team compositions even if there is no recoded procedure for some team compositions. From an analytical perspective, assembling an optimal team is equivalent to minimizing the overlap of team members who have a recurring tendency to be involved with procedures of unfavorable results. A conceptual example shows the accuracy of the proposed system on obtaining the optimal team. FAU - Saberi, Nahid AU - Saberi N FAU - Mahvash, Mohsen AU - Mahvash M FAU - Zenati, Marco AU - Zenati M LA - eng GR - R01 HL079940/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 - Artificial Intelligence MH - *General Surgery/organization & administration MH - Humans MH - *Models, Statistical MH - *Surgeons MH - Treatment Outcome MH - Workforce PMC - PMC5069698 MID - NIHMS822511 EDAT- 2016/01/07 06:00 MHDA- 2016/10/12 06:00 CRDT- 2016/01/07 06:00 PHST- 2016/01/07 06:00 [entrez] PHST- 2016/01/07 06:00 [pubmed] PHST- 2016/10/12 06:00 [medline] AID - 10.1109/EMBC.2015.7318339 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2015;2015:218-21. doi: 10.1109/EMBC.2015.7318339. PMID- 16923009 OWN - NLM STAT- MEDLINE DCOM- 20061220 LR - 20071115 IS - 0147-8389 (Print) IS - 0147-8389 (Linking) VI - 29 IP - 8 DP - 2006 Aug TI - Robotic implantation of a multichamber cardiac resynchronization therapy defibrillator. PG - 906-9 AB - Transvenous implantation of a cardiac resynchronization therapy defibrillator (CRT-D) may not be feasible due to anatomic constraints. One of the most notable advances in minimal-access heart surgery has been the introduction of robotic telemanipulation systems. We present a challenging case in which a CRT-D system was implanted using a robotic approach. Feasibility of such an approach expands the horizons for delivery of CRT-D therapy. FAU - Shalaby, Alaa AU - Shalaby A AD - Division of Cardiology and Cardiovascular Surgery, Pittsburgh VA Healthcare System, Pittsburgh, Pennsylvania 15240, USA. alaa.shalaby@med.va.gov FAU - Sharma, Mahesh S AU - Sharma MS FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Pacing Clin Electrophysiol JT - Pacing and clinical electrophysiology : PACE JID - 7803944 SB - IM CIN - Pacing Clin Electrophysiol. 2006 Aug;29(8):807-9. PMID: 16922994 MH - *Defibrillators, Implantable MH - *Electrodes, Implanted MH - Heart Failure/*prevention & control/*surgery MH - Humans MH - Male MH - Middle Aged MH - Prosthesis Implantation/*methods MH - Robotics/*methods MH - Surgery, Computer-Assisted/*methods MH - Treatment Outcome EDAT- 2006/08/23 09:00 MHDA- 2006/12/21 09:00 CRDT- 2006/08/23 09:00 PHST- 2006/08/23 09:00 [pubmed] PHST- 2006/12/21 09:00 [medline] PHST- 2006/08/23 09:00 [entrez] AID - PACE418 [pii] AID - 10.1111/j.1540-8159.2006.00418.x [doi] PST - ppublish SO - Pacing Clin Electrophysiol. 2006 Aug;29(8):906-9. doi: 10.1111/j.1540-8159.2006.00418.x. PMID- 12950539 OWN - NLM STAT- MEDLINE DCOM- 20040317 LR - 20190910 IS - 1045-3873 (Print) IS - 1045-3873 (Linking) VI - 14 IP - 9 DP - 2003 Sep TI - Left heart pacing lead implantation using subxiphoid videopericardioscopy. PG - 949-53 AB - INTRODUCTION: Recent clinical data support the utility of left heart pacing. The transvenous approach for left heart pacing lead implantation is imperfect. A direct epicardial approach may have advantages, but heretofore its utility has been limited because of the requirement for thoracotomy. We sought to examine the feasibility of a method for epicardial lead implantation that did not require thoracotomy. METHODS AND RESULTS: In five large swine, percutaneous access to the epicardium was achieved with subxiphoid videopericardioscopy, using a device that marries endoscopy with a port through which pacing leads could be introduced. In each animal, standard, active fixation pacing leads were implanted onto the left atrium and ventricle. The atrial lead was implanted at the base of the appendage. The ventricular lead was implanted on the anterior, lateral, and inferior walls. Continuous direct visualization of the epicardium provided guidance for lead localization and fixation, including avoidance of complications such as trauma to epicardial coronary vessels. Capture thresholds were uniformly low. Postmortem examination demonstrated anatomically accurate, uncomplicated lead fixation. CONCLUSION: Using subxiphoid videopericardioscopy, uncomplicated, anatomically accurate left heart epicardial pacing lead implantation can be achieved without thoracotomy. FAU - Zenati, Marco A AU - Zenati MA AD - Center for Minimally Invasive Cardiac Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA. FAU - Bonanomi, Gianluca AU - Bonanomi G FAU - Chin, Albert K AU - Chin A FAU - Schwartzman, David AU - Schwartzman D LA - eng PT - Journal Article PL - United States TA - J Cardiovasc Electrophysiol JT - Journal of cardiovascular electrophysiology JID - 9010756 SB - IM MH - Animals MH - *Cardiac Pacing, Artificial MH - *Electrodes, Implanted MH - *Endoscopy MH - Feasibility Studies MH - Female MH - Male MH - Pericardium/surgery MH - *Surgery, Computer-Assisted MH - Swine MH - *Television MH - Xiphoid Bone EDAT- 2003/09/03 05:00 MHDA- 2004/03/18 05:00 CRDT- 2003/09/03 05:00 PHST- 2003/09/03 05:00 [pubmed] PHST- 2004/03/18 05:00 [medline] PHST- 2003/09/03 05:00 [entrez] AID - 03255 [pii] AID - 10.1046/j.1540-8167.2003.03255.x [doi] PST - ppublish SO - J Cardiovasc Electrophysiol. 2003 Sep;14(9):949-53. doi: 10.1046/j.1540-8167.2003.03255.x. PMID- 8266498 OWN - NLM STAT- MEDLINE DCOM- 19940127 LR - 20061115 IS - 0041-1345 (Print) IS - 0041-1345 (Linking) VI - 25 IP - 6 DP - 1993 Dec TI - Influence of marginal donors on early results after heart transplantation. PG - 3158-9 FAU - Milano, A AU - Milano A AD - Department of Cardiovascular Surgery, University of Padova Medical School, Italy. FAU - Livi, U AU - Livi U FAU - Casula, R AU - Casula R FAU - Bortolotti, U AU - Bortolotti U FAU - Gambino, A AU - Gambino A FAU - Zenati, M AU - Zenati M FAU - Valente, M AU - Valente M FAU - Angelini, A AU - Angelini A FAU - Thiene, G AU - Thiene G FAU - Casarotto, D AU - Casarotto D LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transplant Proc JT - Transplantation proceedings JID - 0243532 SB - IM MH - Actuarial Analysis MH - Adolescent MH - Adult MH - Age Factors MH - Child MH - Child, Preschool MH - Echocardiography MH - Female MH - Heart Arrest MH - Heart Transplantation/mortality/*physiology MH - Humans MH - Immunosuppression/methods MH - Infant MH - Male MH - Middle Aged MH - Resuscitation MH - Retrospective Studies MH - Survival Rate MH - *Tissue Donors MH - Tissue and Organ Procurement/standards EDAT- 1993/12/01 00:00 MHDA- 1993/12/01 00:01 CRDT- 1993/12/01 00:00 PHST- 1993/12/01 00:00 [pubmed] PHST- 1993/12/01 00:01 [medline] PHST- 1993/12/01 00:00 [entrez] PST - ppublish SO - Transplant Proc. 1993 Dec;25(6):3158-9. PMID- 8723191 OWN - NLM STAT- MEDLINE DCOM- 19960920 LR - 20190914 IS - 0934-0874 (Print) IS - 0934-0874 (Linking) VI - 9 IP - 3 DP - 1996 TI - Extracorporeal membrane oxygenation for lung transplant recipients with primary severe donor lung dysfunction. PG - 227-30 AB - Primary severe donor lung dysfunction (DLD) is a significant complication after lung transplantation (LTx), and a high mortality is reported with conventional therapy. The purpose of this report is to review the experience of the University of Pittsburgh with extracorporeal membrane oxygenation (ECMO) for primary severe DLD after LTx. From September 1991 to May 1995, 220 LTx were performed at our center. Eight patients (8/220 = 3.6%) with severe DLD after LTx required ECMO support. The age of LTx recipients was 44 +/- 5 years (mean +/- SD); seven patients were female and one was male. Indications for LTx were: chronic obstructive pulmonary disease in four patients, bronchiectasis in two, and pulmonary hypertension in two. There were three single LTx and five bilateral LTx. The interval from LTx to institution of ECMO was 5.6 +/- 3.2 h (range 0-10 h). Three patients were supported with veno-venous (v-v) ECMO and five had veno-arterial (v-a) ECMO. The duration of ECMO support was 7.3 +/- 4.8 days (range 3-15 days). activated glotting time (ACT) was maintained between 110 and 180 s with intermittent use of heparin. Seven patients (7/8 = 87%) were successfully weaned from ECMO and six patients (6/8 = 75%) were discharged home; they are currently alive after a follow-up of 17 +/- 10.1 months. One patient died on ECMO support for refractory DLD and another died 2 months after ECMO wean from multisystem organ failure. At 6 months follow-up, forced expiratory volume in 1 s (FEV1) is 2.35 +/- 0.91 (75% +/- 17.4% predicted) and mean forced vital capacity (FVC) is 2.53 +/- 0.81 (64% +/- 14% predicted). We conclude that ECMO can be lifesaving when instituted early after primary severe DLD. The v-v ECMO support is preferred when the patient is hemodynamically stable and adequate long-term function of the allograft is anticipated. FAU - Zenati, M AU - Zenati M AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA 15213-2582, USA. FAU - Pham, S M AU - Pham SM FAU - Keenan, R J AU - Keenan RJ FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - England TA - Transpl Int JT - Transplant international : official journal of the European Society for Organ Transplantation JID - 8908516 SB - IM MH - Adult MH - Cardiopulmonary Bypass MH - *Extracorporeal Membrane Oxygenation MH - Female MH - Follow-Up Studies MH - Graft Rejection MH - Humans MH - Ischemia MH - Lung/pathology/physiopathology MH - Lung Transplantation/*physiology MH - Male MH - Middle Aged MH - *Postoperative Complications MH - Reperfusion Injury MH - Risk Factors MH - Time Factors MH - Tissue Donors MH - Transplantation, Homologous EDAT- 1996/01/01 00:00 MHDA- 1996/01/01 00:01 CRDT- 1996/01/01 00:00 PHST- 1996/01/01 00:00 [pubmed] PHST- 1996/01/01 00:01 [medline] PHST- 1996/01/01 00:00 [entrez] AID - 10.1007/BF00335390 [doi] PST - ppublish SO - Transpl Int. 1996;9(3):227-30. doi: 10.1007/BF00335390. PMID- 8823078 OWN - NLM STAT- MEDLINE DCOM- 19961031 LR - 20041117 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 62 IP - 4 DP - 1996 Oct TI - Role of lung reduction in lung transplant candidates with pulmonary emphysema. PG - 994-9 AB - BACKGROUND: The average waiting time for candidates for lung transplantation (LTx) with end-stage emphysema is 21 months with a 15% mortality. We hypothesized that lung reduction might offer an alternative to LTx. METHODS: Of 95 patients with end-stage emphysema evaluated by our LTx program, 45 were accepted for both lung reduction and LTx and 35 underwent lung reduction. RESULTS: All 35 patients survived lung reduction. Thirty patients had a follow-up of 3 months. There was a significant improvement (p < 0.05) of forced expiratory volume in 1 second (0.64 to 0.97 L), forced vital capacity (2.12 to 2.76 L), residual volume (5.62 to 4.26 L), maximum voluntary ventilation (28.1 to 38.5 L/min), 6-minute walk (904 to 1,012 feet), Borg dyspnea index (3.7 to 2.4), and arterial carbon dioxide tension (44.9 to 41.6 mm Hg). Twenty patients (66%) were removed from the LTx list due to their significant improvement (group A). Compared with the remaining 10 patients with 3 months of follow-up (group B), percent increase in forced expiratory volume in 1 second (70% in group A versus 27% in group B) and in forced vital capacity (41% group A versus 18% group B) and percent decrease in residual volume (26% group A versus 1.5% group B) were significantly better in group A (p < 0.01). Seven patients in group B were bridged to LTx; 6 of these patients (86%) had hypercarbia before lung reduction compared with 8 (40%) in group A (p < 0.05). All are alive after LTx: the forced expiratory volume in 1 second is 53% and the forced vital capacity is 64% of predicted. CONCLUSIONS: Lung reduction is safe and effective in selected LTx candidates with end-stage emphysema and has the potential to provide an alternative to LTx. Long-term follow-up is warranted to confirm these results. FAU - Zenati, M AU - Zenati M AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. FAU - Keenan, R J AU - Keenan RJ FAU - Sciurba, F C AU - Sciurba FC FAU - Manzetti, J D AU - Manzetti JD FAU - Landreneau, R J AU - Landreneau RJ FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Adult MH - Aged MH - Endoscopy MH - Female MH - Humans MH - Lung/*surgery MH - *Lung Transplantation MH - Male MH - Middle Aged MH - Pulmonary Emphysema/physiopathology/*surgery MH - Respiratory Mechanics MH - Thoracoscopy EDAT- 1996/10/01 00:00 MHDA- 1996/10/01 00:01 CRDT- 1996/10/01 00:00 PHST- 1996/10/01 00:00 [pubmed] PHST- 1996/10/01 00:01 [medline] PHST- 1996/10/01 00:00 [entrez] AID - 0003-4975(96)00535-8 [pii] AID - 10.1016/0003-4975(96)00535-8 [doi] PST - ppublish SO - Ann Thorac Surg. 1996 Oct;62(4):994-9. doi: 10.1016/0003-4975(96)00535-8. PMID- 7771852 OWN - NLM STAT- MEDLINE DCOM- 19950706 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 59 IP - 6 DP - 1995 Jun TI - Lung reduction as bridge to lung transplantation in pulmonary emphysema. PG - 1581-3 AB - We present a case of bridging to lung transplantation by means of laser ablation of emphysematous bullae in a lung transplant candidate. The patient underwent successful left single-lung transplantation 17 months after lung reduction. He is now well 3 months after transplantation. FAU - Zenati, M AU - Zenati M AD - Division of Cardiothoracic Surgery and Pulmonary Medicine, University of Pittsburgh Medical Center, PA 15213-2582, USA. FAU - Keenan, R J AU - Keenan RJ FAU - Landreneau, R J AU - Landreneau RJ FAU - Paradis, I L AU - Paradis IL FAU - Ferson, P F AU - Ferson PF 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 - AIM SB - IM MH - Humans MH - Laser Therapy MH - *Lung Transplantation MH - Male MH - Middle Aged MH - Pneumonectomy/*methods MH - Pulmonary Emphysema/diagnostic imaging/*surgery MH - Radiography MH - Thoracoscopy MH - Video Recording MH - Waiting Lists EDAT- 1995/06/01 00:00 MHDA- 1995/06/01 00:01 CRDT- 1995/06/01 00:00 PHST- 1995/06/01 00:00 [pubmed] PHST- 1995/06/01 00:01 [medline] PHST- 1995/06/01 00:00 [entrez] AID - 000349759500082V [pii] AID - 10.1016/0003-4975(95)00082-v [doi] PST - ppublish SO - Ann Thorac Surg. 1995 Jun;59(6):1581-3. doi: 10.1016/0003-4975(95)00082-v. PMID- 2693175 OWN - NLM STAT- MEDLINE DCOM- 19900223 LR - 20061115 IS - 0046-5968 (Print) IS - 0046-5968 (Linking) VI - 19 IP - 10 DP - 1989 Oct TI - [New trends in combined transplantation of the heart and lungs]. PG - 913-22 AB - Heart-lung transplantation is a surgical alternative for patients with end-stage lung disease with associated right heart failure. While the procedure is very promising, the morbidity and mortality remain high. The current understanding of the proper selection of candidates, procurement and preservation of donor organs, operative procedure and postoperative care continues to evolve. At the University of Pittsburgh, 70 heart-lung transplantations have been performed since 1982. Early infection and chronic rejection are the major factors influencing survival. Early (less than 2 weeks) intrathoracic infection occurred in 43% of heart-lung transplant recipients, with pneumonia being the most frequent infection. The incidence of pneumonia in heart-lung transplant recipients is twice that in a comparable group of heart recipients. Subclinical pneumonitis in the donor lung, abnormal muco-ciliary clearance and altered allogenic response in the transplanted lung are significant factors associated with the increased incidence of early infections. Chronic rejection, manifested as bronchiolitis obliterans, has occurred in 54% of heart-lung transplantation recipients. Infection caused by cytomegalovirus, Epstein-Barr virus and Pneumocystis carinii have been shown to increase the incidence of bronchiolitis obliterans, as have episodes of acute rejection. Recent reports of a 61% 2-year survival rate represent a substantial improvement over earlier trials. With a better understanding of the pathogenesis of infection in the transplanted lung as well as improved immunosuppressive agents, further improvements in survival can be expected. FAU - Zenati, M AU - Zenati M AD - Department of Surgery, University of Pittsburgh. FAU - Dowling, R D AU - Dowling RD FAU - Yousem, S A AU - Yousem SA FAU - Hardesty, R L AU - Hardesty RL FAU - Griffith, B P AU - Griffith BP FAU - Casarotto, D AU - Casarotto D LA - ita PT - English Abstract PT - Journal Article PT - Review TT - Nuove tendenze nel trapianto combinato di cuore e polmoni. PL - Italy TA - G Ital Cardiol JT - Giornale italiano di cardiologia JID - 1270331 SB - IM MH - *Heart-Lung Transplantation MH - Humans RF - 60 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 - G Ital Cardiol. 1989 Oct;19(10):913-22. PMID- 2596931 OWN - NLM STAT- MEDLINE DCOM- 19900119 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 48 IP - 6 DP - 1989 Dec TI - Organ procurement for pulmonary transplantation. PG - 882-6 AB - Selection of suitable donors is critical to the success of clinical pulmonary transplantation. Requirements for lung donors, management before explantation, and methods of preservation were reviewed for the 70 heart-lung, eight double-lung, and two single-lung transplantations performed at the University of Pittsburgh since 1982. Careful observation of trends of hyperoxygenation studies, chest roentgenograms, and Gram stain and culture results of tracheal secretions, as well as findings on bronchoscopy, can help identify which lungs not only have adequate function but are acceptable for transplantation. In spite of the rigid criteria used, 76% of tracheal cultures from donors deemed acceptable grew organisms. The presence of oropharyngeal flora has been shown to correlate with the development of early intrathoracic infections in the recipient. Prophylactic broad-spectrum antibiotic treatment of the donor is desirable to treat microbial contamination that could cause focal injury to the donor lung and predispose to infection in the recipient. Acceptance of less than ideal donors is ill-advised even though rejection of such donors conflicts with the current shortage of organs. FAU - Zenati, M AU - Zenati M AD - Department of Surgery, University of Pittsburgh, Pennsylvania. FAU - Dowling, R D AU - Dowling RD FAU - Armitage, J M AU - Armitage JM FAU - Kormos, R L AU - Kormos RL FAU - Dummer, J S AU - Dummer JS FAU - Hardesty, R L AU - Hardesty RL FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM CIN - Ann Thorac Surg. 1990 Aug;50(2):335-6. PMID: 2383133 MH - Graft Survival MH - *Heart-Lung Transplantation MH - Humans MH - *Lung Transplantation MH - *Organ Preservation MH - Pennsylvania MH - Postoperative Complications/epidemiology MH - *Tissue Donors MH - *Tissue and Organ Procurement EDAT- 1989/12/01 00:00 MHDA- 1989/12/01 00:01 CRDT- 1989/12/01 00:00 PHST- 1989/12/01 00:00 [pubmed] PHST- 1989/12/01 00:01 [medline] PHST- 1989/12/01 00:00 [entrez] AID - 0003-4975(89)90696-6 [pii] AID - 10.1016/0003-4975(89)90696-6 [doi] PST - ppublish SO - Ann Thorac Surg. 1989 Dec;48(6):882-6. doi: 10.1016/0003-4975(89)90696-6. PMID- 2382220 OWN - NLM STAT- MEDLINE DCOM- 19900910 LR - 20061115 IS - 0039-6060 (Print) IS - 0039-6060 (Linking) VI - 108 IP - 2 DP - 1990 Aug TI - Aerosolized cyclosporine as single-agent immunotherapy in canine lung allografts. PG - 198-204; discussion 204-5 AB - Current systemic immunosuppressive regimens are unable to prevent lung allograft rejection consistently and are associated with significant morbidity and death. Acute rejection has occurred in 40% and chronic rejection in 50% of our lung recipients. We hypothesized that regional immunotherapy with aerosolized cyclosporine would prevent or reduce lung allograft rejection while allowing for low systemic drug delivery. In a canine model of unilateral lung allotransplantation, aerosolized cyclosporine was delivered directly to the allograft. Acute rejection was prevented or reduced in all treated recipients. All control animals had severe acute rejection. Intragraft cyclosporine concentration was high and systemic drug delivery was low, as evidenced by low whole-blood cyclosporine levels and low tissue cyclosporine levels in skeletal muscle. Ninety-five percent of whole-blood trough cyclosporine levels were less than 150 ng/ml. Aerosolized cyclosporine was able to prevent or reduce acute pulmonary rejection and resulted in minimal systemic drug delivery. FAU - Dowling, R D AU - Dowling RD AD - Department of Surgery, University of Pittsburgh, PA 15261. FAU - Zenati, M AU - Zenati M FAU - Burckart, G J AU - Burckart GJ FAU - Yousem, S A AU - Yousem SA FAU - Schaper, M AU - Schaper M FAU - Simmons, R L AU - Simmons RL FAU - Hardesty, R L AU - Hardesty RL FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Surgery JT - Surgery JID - 0417347 RN - 0 (Aerosols) RN - 0 (Cyclosporins) SB - AIM SB - IM MH - Aerosols MH - Animals MH - Cyclosporins/*administration & dosage/pharmacokinetics/pharmacology MH - Dogs MH - Graft Rejection/drug effects MH - *Immunotherapy MH - *Lung Transplantation MH - Transplantation, Homologous EDAT- 1990/08/01 00:00 MHDA- 1990/08/01 00:01 CRDT- 1990/08/01 00:00 PHST- 1990/08/01 00:00 [pubmed] PHST- 1990/08/01 00:01 [medline] PHST- 1990/08/01 00:00 [entrez] PST - ppublish SO - Surgery. 1990 Aug;108(2):198-204; discussion 204-5. PMID- 2368141 OWN - NLM STAT- MEDLINE DCOM- 19900813 LR - 20190713 IS - 0041-1337 (Print) IS - 0041-1337 (Linking) VI - 50 IP - 1 DP - 1990 Jul TI - Primary graft failure following pulmonary transplantation. PG - 165-7 FAU - Zenati, M AU - Zenati M AD - Department of Surgery, University of Pittsburgh, Pennsylvania. FAU - Yousem, S A AU - Yousem SA FAU - Dowling, R D AU - Dowling RD FAU - Stein, K L AU - Stein KL FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - United States TA - Transplantation JT - Transplantation JID - 0132144 SB - IM MH - Adult MH - Female MH - Humans MH - Ischemia/pathology MH - Lung/blood supply/pathology MH - *Lung Transplantation MH - Male EDAT- 1990/07/01 00:00 MHDA- 1990/07/01 00:01 CRDT- 1990/07/01 00:00 PHST- 1990/07/01 00:00 [pubmed] PHST- 1990/07/01 00:01 [medline] PHST- 1990/07/01 00:00 [entrez] AID - 10.1097/00007890-199007000-00034 [doi] PST - ppublish SO - Transplantation. 1990 Jul;50(1):165-7. doi: 10.1097/00007890-199007000-00034. PMID- 2297258 OWN - NLM STAT- MEDLINE DCOM- 19900216 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 49 IP - 1 DP - 1990 Jan TI - Disruption of the aortic anastomosis after heart-lung transplantation. PG - 118-22 AB - Disruption of the aorta at the anastomotic site occurred in 4 of 66 consecutive heart-lung transplant recipients and was associated with a 100% mortality. In 3 of these patients, Candida either was cultured from the suture line or was seen in the wall of the aorta at postmortem examination. In 2 of these 3 patients, cultures of material from the donor trachea taken at the time of explanation grew Candida species. Two patients were seen with sudden massive hemorrhage on postoperative day 26 and postoperative day 28. One patient experienced acute decompensation due to right ventricular outflow tract obstruction on postoperative day 30, and the remaining patient was seen 7 months postoperatively with obstruction of both the left main bronchus and the right pulmonary artery caused by extrinsic compression by an aortic pseudoaneurysm. A high index of suspicion should be maintained when transplanting lungs containing Candida species, as we believe there is substantial evidence of donor transmission of the fungal agents. We now include amphotericin B in our antibiotic prophylactic regimen in an attempt to prevent fungal infection because previous treatment has been uniformly unsuccessful. Furthermore, we wrap both the trachea and the aorta with omentum to lessen the likelihood of mediastinal spread of infection to the aortic suture line. FAU - Dowling, R D AU - Dowling RD AD - Department of Surgery, University of Pittsburgh, Pennsylvania 15261. FAU - Baladi, N AU - Baladi N FAU - Zenati, M AU - Zenati M FAU - Dummer, J S AU - Dummer JS FAU - Kormos, R L AU - Kormos RL FAU - Armitage, J M AU - Armitage JM FAU - Yousem, S A AU - Yousem SA FAU - Hardesty, R L AU - Hardesty RL 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 - AIM SB - IM MH - Adolescent MH - Adult MH - Anastomosis, Surgical/*adverse effects MH - Aneurysm, Infected/complications MH - Aorta/*surgery MH - Aortic Aneurysm/complications MH - Aortic Diseases/*etiology MH - Candidiasis/*complications MH - Child MH - Child, Preschool MH - Female MH - *Heart-Lung Transplantation/methods MH - Humans MH - Male MH - Middle Aged MH - Rupture, Spontaneous MH - Trachea/surgery EDAT- 1990/01/01 00:00 MHDA- 1990/01/01 00:01 CRDT- 1990/01/01 00:00 PHST- 1990/01/01 00:00 [pubmed] PHST- 1990/01/01 00:01 [medline] PHST- 1990/01/01 00:00 [entrez] AID - 0003-4975(90)90368-G [pii] AID - 10.1016/0003-4975(90)90368-g [doi] PST - ppublish SO - Ann Thorac Surg. 1990 Jan;49(1):118-22. doi: 10.1016/0003-4975(90)90368-g. PMID- 2231088 OWN - NLM STAT- MEDLINE DCOM- 19901224 LR - 20041117 IS - 0887-2570 (Print) IS - 0887-2570 (Linking) VI - 9 IP - 5 DP - 1990 Sep-Oct TI - Influence of the donor lung on development of early infections in lung transplant recipients. PG - 502-8; discussion 508-9 AB - Infection of the lung allograft is the greatest cause of morbidity and mortality after heart-lung transplantation. To better understand the pathogenesis of these infections, we compared the results from cultures of the donor tracheas with the type and prevalence of early intrathoracic infections in the recipients. In the last 37 recipients, intrathoracic infections occurred within 2 weeks of operation in 16 (43%). Organisms isolated from the donor tracheal cultures were different from those associated with early infections, except for three of four recipients with heavy growth of Candida in donor tracheal cultures, in whom fatal invasive candidiasis developed caused by the same species of Candida isolated from the donor culture. Comparisons were made between recipients with (n = 16) and without early infection (n = 21) for age of donors and recipients, ischemic time, length of donor stay in an intensive care unit, donor arterial oxygen pressure, duration of recipient intubation, sterile donor tracheal culture or culture with presence of mouth flora, bacterial pathogens, or Candida, method of lung preservation, and antibiotic prophylaxis of donor. The only factor significantly associated with the onset of early infection was the presence of mouth flora in the donor tracheal culture (p = 0.004, Fisher's exact test, two sided). Multiple logistic regression was performed to test the additional contribution of other covariates after adjusting for the presence of mouth flora. None of the other covariates contributed to the occurrence of early infection. Recipients with early infection had a significantly lower survival compared with those without early infection (p = 0.04) by the Kaplan-Meier survival analysis.(ABSTRACT TRUNCATED AT 400 WORDS) FAU - Zenati, M AU - Zenati M AD - Department of Surgery, University of Pittsburgh, PA 15261. FAU - Dowling, R D AU - Dowling RD FAU - Dummer, J S AU - Dummer JS FAU - Paradis, I L AU - Paradis IL FAU - Arena, V C AU - Arena VC FAU - Armitage, J M AU - Armitage JM FAU - Kormos, R L AU - Kormos RL FAU - Hardesty, R L AU - Hardesty RL FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - United States TA - J Heart Transplant JT - The Journal of heart transplantation JID - 8604172 SB - IM MH - Adolescent MH - Adult MH - Candidiasis/*etiology MH - Female MH - Humans MH - Lung/*microbiology MH - *Lung Transplantation/mortality MH - Male MH - Mediastinitis/*microbiology MH - Pneumonia/*microbiology MH - Postoperative Complications/*microbiology MH - Pseudomonas Infections/*etiology MH - Regression Analysis MH - Survival Analysis MH - Time Factors MH - *Tissue Donors MH - Trachea/microbiology EDAT- 1990/09/01 00:00 MHDA- 1990/09/01 00:01 CRDT- 1990/09/01 00:00 PHST- 1990/09/01 00:00 [pubmed] PHST- 1990/09/01 00:01 [medline] PHST- 1990/09/01 00:00 [entrez] PST - ppublish SO - J Heart Transplant. 1990 Sep-Oct;9(5):502-8; discussion 508-9. PMID- 2186527 OWN - NLM STAT- MEDLINE DCOM- 19900613 LR - 20190713 IS - 0041-1337 (Print) IS - 0041-1337 (Linking) VI - 49 IP - 5 DP - 1990 May TI - HLA-class II antigen expression in human heart-lung allografts. PG - 991-5 AB - Long-term survival in heart-lung transplantation has ben hindered by the development of bronchiolitis obliterans (OB), which is believed to be a manifestation of chronic rejection of the lung. Since HLA-class II antigens are involved in the rejection response, the distribution of the class II products HLA-DR, HLA-DQ, and HLA-DP were studied in normal lung, and in transplanted lung with and without OB, utilizing frozen-section immunohistochemical techniques. All three allelic products are usually expressed on the epithelial, endothelial, and mesenchymal components of the lung. Sequential transbronchial biopsies from 4 recipients before and concurrent with the diagnosis of OB were stained with serial dilutions of monoclonal antibodies to assess the level of expression of the above class II products. Increased levels of HLA-DR and HLA-DP antigens may be seen on the bronchial and bronchiolar epithelium during OB, but the changes are subtle and complicated by many other variables. Additional studies are needed to confirm these preliminary results. FAU - Yousem, S A AU - Yousem SA AD - Department of Pathology, Presbyterian University Hospital, University of Pittsburgh School of Medicine, Pennsylvania 15213. FAU - Curley, J M AU - Curley JM FAU - Dauber, J AU - Dauber J FAU - Paradis, I AU - Paradis I FAU - Rabinowich, H AU - Rabinowich H FAU - Zeevi, A AU - Zeevi A FAU - Duquesnoy, R AU - Duquesnoy R FAU - Dowling, R AU - Dowling R FAU - Zenati, M AU - Zenati M FAU - Hardesty, R AU - Hardesty R AU - et al. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transplantation JT - Transplantation JID - 0132144 RN - 0 (HLA-D Antigens) SB - IM MH - Bronchiolitis Obliterans/immunology/pathology MH - HLA-D Antigens/*immunology MH - Heart-Lung Transplantation/*immunology/pathology MH - Humans MH - Immunoenzyme Techniques MH - Lung/immunology EDAT- 1990/05/01 00:00 MHDA- 1990/05/01 00:01 CRDT- 1990/05/01 00:00 PHST- 1990/05/01 00:00 [pubmed] PHST- 1990/05/01 00:01 [medline] PHST- 1990/05/01 00:00 [entrez] AID - 10.1097/00007890-199005000-00030 [doi] PST - ppublish SO - Transplantation. 1990 May;49(5):991-5. doi: 10.1097/00007890-199005000-00030. PMID- 2189657 OWN - NLM STAT- MEDLINE DCOM- 19900711 LR - 20061115 IS - 0272-5231 (Print) IS - 0272-5231 (Linking) VI - 11 IP - 2 DP - 1990 Jun TI - The pulmonary donor. PG - 217-26 AB - This article discusses the Pittsburgh experience with the pulmonary donor and provides guidelines for the maintenance and selection of appropriate donor lungs. Criteria for the selection of the pulmonary donor include absence of radiographic abnormality, minimal ventilation-perfusion mismatch, and an absence of identifiable infection. Because early thoracic infections result in a high mortality, donors are excluded if white cells, fungi, or bacteria are noted in samples obtained from tracheal aspirates or bronchoscopic examination. A number of techniques for the procurement of donor lungs are currently satisfactory and include core cooling with the use of cardiopulmonary bypass and different hypothermic pulmonary artery flush solutions. Other clinical preservation techniques are discussed, including autoperfusion and the use of blood-based pulmoplegia and University of Wisconsin storage solution. Because so much of the outcome following pulmonary allografting is based on the quality of the donor lungs, much of the future direction in pulmonary transplantation must be directed toward a continuing investigation of better methods for selection and maintenance of the donor and ex vivo preservation. FAU - Griffith, B P AU - Griffith BP AD - Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania. FAU - Zenati, M AU - Zenati M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Clin Chest Med JT - Clinics in chest medicine JID - 7907612 SB - IM MH - Adult MH - Humans MH - Lung/surgery MH - Lung Diseases/surgery MH - *Lung Transplantation/methods MH - Middle Aged MH - *Tissue Donors MH - Tissue and Organ Procurement/methods RF - 43 EDAT- 1990/06/01 00:00 MHDA- 1990/06/01 00:01 CRDT- 1990/06/01 00:00 PHST- 1990/06/01 00:00 [pubmed] PHST- 1990/06/01 00:01 [medline] PHST- 1990/06/01 00:00 [entrez] PST - ppublish SO - Clin Chest Med. 1990 Jun;11(2):217-26. PMID- 9726611 OWN - NLM STAT- MEDLINE DCOM- 19981028 LR - 20190512 IS - 1010-7940 (Print) IS - 1010-7940 (Linking) VI - 14 IP - 1 DP - 1998 Jul TI - Lung volume reduction or lung transplantation for end-stage pulmonary emphysema? PG - 27-31; discussion 31-2 AB - OBJECTIVE: As the waiting period for lung transplant (LT) candidates with end-stage pulmonary emphysema (COPD) continues to increase, there is a need for alternative treatments to reduce the morbidity and mortality associated with COPD. We hypothesized that lung reduction (LR) may avoid the need for subsequent LT in patients on the waiting list that are also candidates for LR. METHODS: From July 1994 to December 1995, 20 patients received LR as alternative to LT. The average age was 58 +/- 7 years; 11 were males. Eighteen patients had primary COPD and two had alpha-1 antitrypsin deficiency. Eighteen LRs were thoracoscopic (two bilateral and 16 unilateral) and two were done through a median sternotomy. RESULTS: At a follow-up of 32 +/- 4 months, 19 patients are alive (19/20 = 95%). Fifteen patients (15/20 = 75%) are currently off the LT list and doing well: FEV1 is 40 +/- 18% predicted at 2 years compared with 22.7 +/- 6% before LR (P < 0.001); FVC is 84 +/- 13% at 2 years compared with 55 +/- 7% (P < 0.001) and the RV is 145 +/- 59% compared with 270 +/- 58% (P < 0.001). One patient (5%) required extra-corporeal membrane oxygenation (ECMO) after LR to the contralateral side of the first procedure and subsequently died. Two patients (10%) are currently listed for LT because of persistent symptoms. One patient (5%) in whom deterioration was secondary to exposure to toxic fumes, underwent successful LT. One patient (5%) is doing well from the pulmonary standpoint but is being worked up for new severe coronary artery disease (CAD). The freedom from LT is 95% (19/20) and the freedom from repeat LR is 85% (17/20). CONCLUSIONS: LR has the potential to offer an effective palliative alternative to LT in 75% of selected patients up to 32 months of follow-up. Widespread use of bilateral LR is anticipated to further improve the results. FAU - Zenati, M AU - Zenati M AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA 15213, USA. zenati@pittsurg.upmc.edu FAU - Keenan, R J AU - Keenan RJ FAU - Courcoulas, A P AU - Courcoulas AP FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Aged MH - Endoscopy MH - Female MH - Humans MH - *Lung Transplantation MH - Male MH - Middle Aged MH - *Pneumonectomy/methods MH - Pulmonary Emphysema/complications/physiopathology/*surgery MH - Respiratory Mechanics MH - Thoracoscopy MH - Treatment Outcome MH - alpha 1-Antitrypsin Deficiency/complications EDAT- 1998/09/03 00:00 MHDA- 1998/09/03 00:01 CRDT- 1998/09/03 00:00 PHST- 1998/09/03 00:00 [pubmed] PHST- 1998/09/03 00:01 [medline] PHST- 1998/09/03 00:00 [entrez] AID - S1010-7940(98)00132-8 [pii] AID - 10.1016/s1010-7940(98)00132-8 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 1998 Jul;14(1):27-31; discussion 31-2. doi: 10.1016/s1010-7940(98)00132-8. PMID- 1733067 OWN - NLM STAT- MEDLINE DCOM- 19920224 LR - 20190713 IS - 0041-1337 (Print) IS - 0041-1337 (Linking) VI - 53 IP - 1 DP - 1992 Jan TI - Improved immunosuppression with aerosolized cyclosporine in experimental pulmonary transplantation. PG - 20-5 AB - Rejection remains a major obstacle to long-term success of pulmonary transplantation. Direct delivery of cyclosporine to lung allografts may produce better control of rejection by generating high intragraft concentrations of drug with decreased systemic delivery and toxicity. The efficacy of inhaled cyclosporine in preventing allograft rejection was compared with systemic delivery by intramuscular injections in a rat model of lung transplantation (Brown-Norway to Lewis). Group 1 animals were given no immunosuppression. Group 2 received a single i.m. injection of 25 mg/kg CsA on the day of operation while group 3 received daily doses on postoperative days 0-3. Groups 4-7 received aerosolized CsA daily for seven days. The aerosol generator produced an airborne concentration of CsA of 180 mg/m3 with a mean particle size of 0.7 mu and estimated pulmonary depositions of CsA of 0.98-3.6 mg/kg/day. Animals were killed on POD 7, and the transplanted lungs graded histologically in a blinded fashion. All control animals showed destructive grade 4 changes by POD 7. Animals receiving high-dose aerosolized CsA (groups 6 and 7) showed minimal changes with a mean rejection grade of 1.3. A single i.m. dose of CsA (group 2) failed to prevent rejection; the mean grade was 2.2. Animals given four i.m. doses of CsA had a mean grade of 1.8. Aerosolized CsA provided significantly better control of rejection than did systemic CsA (groups 6 and 7 vs. groups 2 and 3; P less than 0.0002 and less than 0.0054, respectively). Local delivery of CsA by aerosol inhalation is effective in limiting acute rejection of the rat lung allograft. FAU - Keenan, R J AU - Keenan RJ AD - Department of Surgery, School of Medicine, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261. FAU - Duncan, A J AU - Duncan AJ FAU - Yousem, S A AU - Yousem SA FAU - Zenati, M AU - Zenati M FAU - Schaper, M AU - Schaper M FAU - Dowling, R D AU - Dowling RD FAU - Alarie, Y AU - Alarie Y FAU - Burckart, G J AU - Burckart GJ FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Transplantation JT - Transplantation JID - 0132144 RN - 0 (Aerosols) RN - 83HN0GTJ6D (Cyclosporine) SB - IM MH - Aerosols MH - Animals MH - Cyclosporine/*administration & dosage/blood MH - Graft Rejection/drug effects MH - Graft Survival/drug effects MH - *Lung Transplantation MH - Male MH - Rats MH - Transplantation, Homologous EDAT- 1992/01/01 00:00 MHDA- 1992/01/01 00:01 CRDT- 1992/01/01 00:00 PHST- 1992/01/01 00:00 [pubmed] PHST- 1992/01/01 00:01 [medline] PHST- 1992/01/01 00:00 [entrez] AID - 10.1097/00007890-199201000-00003 [doi] PST - ppublish SO - Transplantation. 1992 Jan;53(1):20-5. doi: 10.1097/00007890-199201000-00003. PMID- 1859667 OWN - NLM STAT- MEDLINE DCOM- 19910830 LR - 20190510 IS - 1010-7940 (Print) IS - 1010-7940 (Linking) VI - 5 IP - 5 DP - 1991 TI - Immunosuppression with aerosolized cyclosporine for prevention of lung rejection in a rat model. PG - 266-71; discussion 272 AB - The efficacy of local delivery of aerosol cyclosporine (CsA) for prevention of lung rejection was compared with the intramuscular route (IM) in a fully allogeneic rat model (BN/LEW) of lung transplantation (LTx). Control rats (group 1, n = 6) received no CsA after LTx. Rats in group 2 (n = 10) received 4 doses of CsA in olive oil (25 mg/kg) intramuscularly starting on postoperative day (POD) 0. Group 3 (n = 9) was treated with aerosolized CsA for 3 h/day for 7 days starting on POD 0. All animals were sacrificed on POD 6. Transplanted lungs were graded histologically in a blind manner on a 0-4 scale. Control animals all showed grade 4 rejection. i.m. CsA therapy reduced lung rejection with a rejection grade of 1.8 +/- 0.35 (mean +/- SD) but was associated with a 50% incidence of pneumonia. Aerosol CsA provided better control of rejection with a rejection grade of 1.2 +/- 0.4 (group 3 vs. group 2: P less than 0.05 Wilcoxon) and none of these animals had penumonia. Trough blood levels of CsA were significantly lower in the group treated with aerosolized CsA when compared with the IM group (P less than 0.05). Therefore we conclude that: (1) aerosol CsA is effective in preventing lung allograft rejection following lung transplantation in rats, and (2) local delivery of aerosol CsA is superior to the i.m. route because better control of rejection is achieved with a lower systemic delivery of CsA. FAU - Zenati, M AU - Zenati M AD - Division of Cardiac Surgery, University of Verona, Italy. FAU - Duncan, A J AU - Duncan AJ FAU - Burckart, G J AU - Burckart GJ FAU - Schaper, M AU - Schaper M FAU - Yousem, S A AU - Yousem SA FAU - Griffith, B P AU - Griffith BP FAU - Casarotto, D AU - Casarotto D LA - eng PT - Journal Article PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 RN - 0 (Aerosols) RN - 0 (Cyclosporins) SB - IM MH - Aerosols MH - Animals MH - Cyclosporins/*administration & dosage/pharmacokinetics MH - Graft Rejection/*drug effects MH - Lung/pathology MH - Lung Transplantation/*immunology MH - Rats MH - Rats, Inbred BN EDAT- 1991/01/01 00:00 MHDA- 1991/01/01 00:01 CRDT- 1991/01/01 00:00 PHST- 1991/01/01 00:00 [pubmed] PHST- 1991/01/01 00:01 [medline] PHST- 1991/01/01 00:00 [entrez] AID - 10.1016/1010-7940(91)90175-j [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 1991;5(5):266-71; discussion 272. doi: 10.1016/1010-7940(91)90175-j. PMID- 12022555 OWN - NLM STAT- MEDLINE DCOM- 20020610 LR - 20190628 IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 73 IP - 5 DP - 2002 May TI - Outcomes of lung volume reduction surgery followed by lung transplantation: a matched cohort study. PG - 1587-93 AB - BACKGROUND: Lung volume reduction surgery (LVRS) has been demonstrated to provide symptomatic relief and to improve lung function in patients with end-stage emphysema. The goal of this study was to assess the additional morbidity associated with lung transplantation after LVRS for end-stage emphysema with regard to immediate postoperative outcomes, longitudinal spirometry, and survival rates compared to an age-, gender-, procedure-matched, and transplant time-matched cohort that had lung transplantation alone. METHODS: We compared the postoperative and long-term outcomes of a sequential procedure cohort to a matched cohort to assess the possible added post-transplant morbidity. RESULTS: Fifteen patients who underwent sequential LVRS (including 11 unilateral LVRS, 4 bilateral LVRS) and lung transplantation (ipsilateral in 7 and contralateral in 8) on average 28.1 +/- 17.2 months (median, 27.4 months; range, 3.7 to 61.7 months) later were assessed. No significant differences were noted in pretransplant demographics, post-transplant variables, longitudinal spirometric indices, or survival. A trend toward a lower pretransplant arterial carbon dioxide tension was apparent in the sequential procedure cohort. Group analysis revealed a significant increase in the number of patients requiring transfusion and in the total number of units transfused in patients undergoing ispsilateral transplantation after LVRS; a significant increase in the length of intensive care unit stay; and a trend toward an increase in the duration of hospital stay in patients undergoing lung transplantation within 18 months of LVRS. CONCLUSIONS: In appropriate candidates, LVRS bridged the time to transplantation by an average of 28.1 +/- 17.2 months (median, 27.4 months; range, 3.7 to 61.7 months) without significantly increasing post-transplant morbidity or mortality. Furthermore, bilateral LVRS bridged the time to transplantation to a greater extent than unilateral LVRS (34.9 +/- 29.8 months; median, 32.1 months versus 25.4 +/- 16.3 months; median, 22.3 months; p = 0.23). FAU - Burns, Karen E A AU - Burns KE AD - Division of Pulmonary Transplantation, The University of Pittsburgh Medical Center, Pennsylvania, USA. FAU - Keenan, Robert J AU - Keenan RJ FAU - Grgurich, Wayne F AU - Grgurich WF FAU - Manzetti, Jan D AU - Manzetti JD FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - AIM SB - IM MH - Aged MH - Cohort Studies MH - Female MH - Follow-Up Studies MH - Humans MH - *Lung Transplantation MH - Male MH - Middle Aged MH - *Pneumonectomy MH - Postoperative Complications/*etiology/mortality MH - Pulmonary Emphysema/mortality/*surgery MH - Spirometry MH - Survival Rate EDAT- 2002/05/23 10:00 MHDA- 2002/06/11 10:01 CRDT- 2002/05/23 10:00 PHST- 2002/05/23 10:00 [pubmed] PHST- 2002/06/11 10:01 [medline] PHST- 2002/05/23 10:00 [entrez] AID - S0003-4975(02)03499-9 [pii] AID - 10.1016/s0003-4975(02)03499-9 [doi] PST - ppublish SO - Ann Thorac Surg. 2002 May;73(5):1587-93. doi: 10.1016/s0003-4975(02)03499-9. PMID- 14761775 OWN - NLM STAT- MEDLINE DCOM- 20040527 LR - 20161124 IS - 1053-2498 (Print) IS - 1053-2498 (Linking) VI - 23 IP - 2 DP - 2004 Feb TI - Serial dobutamine stress echocardiography with Doppler assessment of the left internal thoracic artery graft after minimally invasive bypass for a patient with an orthotopic heart transplant. PG - 256-9 AB - Select patients who have undergone orthotopic heart transplantation with proximal left anterior disease may be candidates for minimally invasive direct coronary artery bypass surgery. Combining left internal thoracic artery transthoracic Doppler flow assessment with wall motion assessment during dobutamine stress echocardiography adds to the utility of this test by focusing attention on the graft's status as well as detecting ischemia due to cardiac allograft vasculopathy. FAU - Grewal, Harpreet Singh AU - Grewal HS AD - Department of Medicine, University of Pittsburgh Cardiovascular Institute, Pittsburgh, Pennsylvania 15213, USA. FAU - Zenati, Marco A AU - Zenati MA FAU - Kormos, Robert AU - Kormos R FAU - Murali, Srinivas AU - Murali S FAU - Katz, William E AU - Katz WE LA - eng PT - Case Reports PT - Journal Article PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 SB - IM MH - Aged MH - *Coronary Artery Bypass/methods MH - Coronary Disease/*diagnostic imaging/epidemiology/etiology MH - *Echocardiography, Stress MH - *Heart Transplantation MH - Humans MH - Male MH - Minimally Invasive Surgical Procedures MH - Postoperative Complications/*diagnostic imaging/epidemiology MH - Thoracic Arteries/*diagnostic imaging/*transplantation EDAT- 2004/02/06 05:00 MHDA- 2004/05/28 05:00 CRDT- 2004/02/06 05:00 PHST- 2002/12/03 00:00 [received] PHST- 2003/03/05 00:00 [revised] PHST- 2003/03/09 00:00 [accepted] PHST- 2004/02/06 05:00 [pubmed] PHST- 2004/05/28 05:00 [medline] PHST- 2004/02/06 05:00 [entrez] AID - S1053249803001463 [pii] AID - 10.1016/S1053-2498(03)00146-3 [doi] PST - ppublish SO - J Heart Lung Transplant. 2004 Feb;23(2):256-9. doi: 10.1016/S1053-2498(03)00146-3. PMID- 20401174 OWN - NLM STAT- Publisher LR - 20191120 IS - 1559-0879 (Electronic) IS - 1556-9845 (Print) IS - 1556-9845 (Linking) VI - 5 IP - 1 DP - 2010 Jan TI - Impact of Subxiphoid Video Pericardioscopy with a Rigid Shaft on Cardiac Hemodynamics in a Porcine Model. PG - 51-54 AB - OBJECTIVE: Single-port subxiphoid videopericardioscopy with a rigid shaft is useful for left atrial exclusion, left ventricular pacing lead implantation, and epicardial mapping, but it may interfere with the cardiac rhythm and adversely alter hemodynamics. We examined the impact of this technique on hemodynamic indices in a porcine model. METHODS: The videopericardioscopy device was introduced into the pericardial space of 5 pigs (35-45 kg) via a subxiphoid approach and navigated to 6 anatomical targets (right atrial appendage, superior vena cava, ascending aorta, left atrial appendage (anterior and posterior approaches), transverse sinus, and atrioventricular groove). After successful target acquisition, the device was withdrawn through the subxiphoid port. When the hemodynamics stabilized, the device was navigated to another target. The heart rate, arterial blood pressure, central venous pressure, pulmonary arterial pressure, and mixed venous oxygen saturation were measured at every pre-target (subxiphoid incision) and target point. After the navigation trials, the animals were sacrificed and the mediastinum space was examined for procedure-related injuries. RESULTS: The device afforded a good view, and the navigation trials were successfully performed on the beating heart. Four animals tolerated the procedures, while 1 died of device-induced ventricular fibrillation after the trials. Hemodynamics were severely compromised at all anatomical targets except the left atrial appendage (anterior approach). CONCLUSIONS: Subxiphoid videopericardioscopy significantly interferes with the cardiac rhythm, causing life-threatening arrhythmia and hemodynamic compromise, when the target is located deep and far from the pericardiotomy. A flexible or highly articulated device would enable intrapericardial navigation without hemodynamic compromise. FAU - Yokota, Takenori AU - Yokota T AD - Division of Cardiac Surgery, the Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, PA USA. FAU - Ota, Takeyoshi AU - Ota T FAU - Schwartzman, David AU - Schwartzman D FAU - Zenati, Marco A AU - Zenati MA LA - eng GR - R01 HL079940/HL/NHLBI NIH HHS/United States GR - R01 HL079940-04/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Innovations (Phila) JT - Innovations (Philadelphia, Pa.) JID - 101257528 PMC - PMC2854418 MID - NIHMS181103 EDAT- 2010/04/20 06:00 MHDA- 2010/04/20 06:00 CRDT- 2010/04/20 06:00 PHST- 2010/04/20 06:00 [entrez] PHST- 2010/04/20 06:00 [pubmed] PHST- 2010/04/20 06:00 [medline] AID - 10.1097/IMI.0b013e3181ceef8a [doi] PST - ppublish SO - Innovations (Phila). 2010 Jan;5(1):51-54. doi: 10.1097/IMI.0b013e3181ceef8a. PMID- 1453746 OWN - NLM STAT- MEDLINE DCOM- 19930106 LR - 20041117 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 104 IP - 6 DP - 1992 Dec TI - Pulmonary atresia and intact ventricular septum associated with pulmonary artery sling. PG - 1755-6 FAU - Zenati, M AU - Zenati M FAU - del Nonno, F AU - del Nonno F FAU - Marino, B AU - Marino B FAU - di Carlo, D C AU - di Carlo DC LA - eng PT - Case Reports PT - Letter PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - AIM SB - IM MH - *Abnormalities, Multiple/surgery MH - *Heart Defects, Congenital/surgery MH - Heart Septum MH - Humans MH - Infant, Newborn MH - Male MH - Pulmonary Artery/*abnormalities/surgery EDAT- 1992/12/01 00:00 MHDA- 1992/12/01 00:01 CRDT- 1992/12/01 00:00 PHST- 1992/12/01 00:00 [pubmed] PHST- 1992/12/01 00:01 [medline] PHST- 1992/12/01 00:00 [entrez] PST - ppublish SO - J Thorac Cardiovasc Surg. 1992 Dec;104(6):1755-6. PMID- 24850549 OWN - NLM STAT- MEDLINE DCOM- 20150128 LR - 20181113 IS - 1757-790X (Electronic) IS - 1757-790X (Linking) VI - 2014 DP - 2014 May 21 TI - Post occlusive left atrial appendage thrombosis with extension into the left atrium. LID - 10.1136/bcr-2013-200969 [doi] LID - bcr2013200969 AB - A 67-year-old man underwent left atrial appendage (LAA) exclusion concomitant with mitral valve surgery and radiofrequency ablation maze procedure. On transoesophageal echocardiography anticipating ablation for left atrial tachycardia, an echodense thrombus was visualised in the LAA location with apparent intracavitary extension into the left atrium. Based on CT imaging findings, the echo represented thrombosis of a large left atrial appendage with probable extension into the left atrium. CI - 2014 BMJ Publishing Group Ltd. FAU - Shalaby, Alaa AU - Shalaby A AD - Division of Cardiology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA University of Pittsburgh Medical Center: Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA. FAU - Refaat, Marwan AU - Refaat M AD - University of Pittsburgh Medical Center: Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA. FAU - Lacomis, Joan AU - Lacomis J AD - University of Pittsburgh Medical Center: Division of Radiology, Pittsburgh, Pennsylvania, USA. FAU - Zenati, Marco AU - Zenati M AD - University of Pittsburgh Medical Center: Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA. LA - eng PT - Case Reports PT - Journal Article DEP - 20140521 TA - BMJ Case Rep JT - BMJ case reports JID - 101526291 SB - IM MH - Aged MH - Atrial Appendage/diagnostic imaging/*surgery/ultrastructure MH - Atrial Fibrillation/surgery MH - Echocardiography, Transesophageal MH - Humans MH - Male MH - Mitral Valve Insufficiency/surgery MH - Postoperative Complications/diagnosis/*etiology MH - Thrombosis/diagnosis/*etiology MH - Tomography, X-Ray Computed PMC - PMC4039833 EDAT- 2014/05/23 06:00 MHDA- 2015/01/30 06:00 CRDT- 2014/05/23 06:00 PHST- 2014/05/23 06:00 [entrez] PHST- 2014/05/23 06:00 [pubmed] PHST- 2015/01/30 06:00 [medline] AID - bcr-2013-200969 [pii] AID - 10.1136/bcr-2013-200969 [doi] PST - epublish SO - BMJ Case Rep. 2014 May 21;2014:bcr2013200969. doi: 10.1136/bcr-2013-200969. PMID- 21168015 OWN - NLM STAT- MEDLINE DCOM- 20110113 LR - 20161125 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) VI - 141 IP - 1 DP - 2011 Jan TI - Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve). PG - 91-7 LID - 10.1016/j.jtcvs.2010.08.057 [doi] AB - OBJECTIVE: Functional ischemic mitral regurgitation is a complication of ventricular remodeling; standard therapy is reduction annuloplasty and coronary artery bypass grafting. Unfortunately, outcomes are retrospective and contradictory. We report a multicenter study that documents the outcomes of reduction annuloplasty for functional ischemic mitral regurgitation. METHODS: Twenty-one centers randomized 75 patients to the coronary artery bypass grafting + reduction annuloplasty subgroup that was the control arm of the Randomized Evaluation of a Surgical Treatment for Off-pump Repair of the Mitral Valve trial. Entry criteria included patients requiring revascularization, patients with severe or symptomatic moderate functional ischemic mitral regurgitation, an ejection fraction 25% or greater, a left ventricular end-diastolic dimension 7.0 cm or less, and more than 30 days since acute myocardial infarction. All echocardiograms were independently scored by a core laboratory. Reduction annuloplasty was achieved by device annuloplasty. Two patients underwent immediate intraoperative conversion to a valve replacement because reduction annuloplasty was unable to correct mitral regurgitation; as-treated results are presented. RESULTS: Thirty-day mortality was 4.1% (3/73). Patients received an average of 2.8 bypass grafts. Mean follow-up was 24.6 months. Mitral regurgitation was reduced from 2.6 ± 0.8 preoperatively to 0.3 ± 0.6 at 2 years. Freedom from death or valve reoperation was 78% ± 5% at 2 years. There was significant improvement in ejection fraction and New York Heart Association class with reduction of left ventricular end-diastolic dimension. Cox regression analyses suggested that increasing age (P = .001; hazard ratio, 1.16 per year; 95% confidence interval, 1.06-1.26) and renal disease (P = .018; hazard ratio, 3.48; 95% confidence interval, 1.25-9.72) were associated with decreased survival. CONCLUSIONS: Coronary artery bypass grafting + reduction annuloplasty for functional ischemic mitral regurgitation predictably reduces mitral regurgitation and relieves symptoms. This treatment of moderate to severe mitral regurgitation is associated with improved indices of ventricular function, improved New York Heart Association class, and excellent freedom from recurrent mitral insufficiency. Although long-term prognosis remains guarded, this multicenter study delineates the intermediate-term benefits of such an approach. CI - Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. FAU - Grossi, Eugene A AU - Grossi EA AD - New York University School of Medicine, New York, NY 10016, USA. Eugene.grossi@nyumc.org FAU - Woo, Y Joseph AU - Woo YJ FAU - Patel, Nirav AU - Patel N FAU - Goldberg, Judith D AU - Goldberg JD FAU - Schwartz, Charles F AU - Schwartz CF FAU - Subramanian, Valavanur A AU - Subramanian VA FAU - Genco, Christopher AU - Genco C FAU - Goldman, Scott M AU - Goldman SM FAU - Zenati, Marco A AU - Zenati MA FAU - Wolfe, J Alan AU - Wolfe JA FAU - Mishra, Yugal K AU - Mishra YK FAU - Trehan, Naresh AU - Trehan N LA - eng SI - ClinicalTrials.gov/NCT00120276 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - AIM SB - IM MH - Aged MH - *Coronary Artery Bypass/adverse effects/mortality MH - Early Termination of Clinical Trials MH - *Heart Valve Prosthesis Implantation/adverse effects/mortality MH - Humans MH - Middle Aged MH - *Mitral Valve Annuloplasty/adverse effects/mortality MH - Mitral Valve Insufficiency/diagnostic imaging/etiology/mortality/physiopathology/*surgery MH - Myocardial Ischemia/*complications/diagnostic imaging/mortality/physiopathology MH - Proportional Hazards Models MH - Prospective Studies MH - Recovery of Function MH - Reoperation MH - Risk Assessment MH - Risk Factors MH - Severity of Illness Index MH - Stroke Volume MH - Time Factors MH - Treatment Outcome MH - Ultrasonography MH - United States MH - Ventricular Function, Left MH - Ventricular Remodeling EDAT- 2010/12/21 06:00 MHDA- 2011/01/14 06:00 CRDT- 2010/12/21 06:00 PHST- 2010/06/18 00:00 [received] PHST- 2010/08/05 00:00 [revised] PHST- 2010/08/24 00:00 [accepted] PHST- 2010/12/21 06:00 [entrez] PHST- 2010/12/21 06:00 [pubmed] PHST- 2011/01/14 06:00 [medline] AID - S0022-5223(10)01059-7 [pii] AID - 10.1016/j.jtcvs.2010.08.057 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2011 Jan;141(1):91-7. doi: 10.1016/j.jtcvs.2010.08.057. PMID- 22436755 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20131018 LR - 20120322 IS - 1556-9845 (Print) IS - 1556-9845 (Linking) VI - 1 IP - 5 DP - 2006 Fall TI - Patency outcomes of aortic connectors. PG - 255-7 AB - OBJECTIVE: : Controlled outcome analysis of mechanical aortic connectors for proximal saphenous vein bypass graft anastomosis is lacking. We report the clinical and angiographic outcome of patients receiving the Symmetry aortic connector (St. Jude Medical, Inc St. Paul, MN, US) within a multicenter, prospective, randomized study. METHODS: : Twenty-five patients at 3 study sites received aortic connectors at the time of coronary artery bypass surgery. Protocol-defined angiographic follow-up was completed in 19 of 25 patients (76%) at time-points up to 14 months postoperatively; 32 connector anastomoses were evaluated in these 19 patients. Beating heart surgery was performed in 17 patients, and 2 were performed with cardiopulmonary bypass. Age was 69.7 ± 8.1 year; all patients were males. RESULTS: : The connector anastomosis patency rate was 15.6% (5/32). There were no deaths during the follow-up period. Four patients (21%) suffered myocardial infarction and 2 additional patients (10.5%) required percutaneous coronary interventions; one of who required 3 percutaneous coronary interventions, the other received one percutaneous coronary intervention. CONCLUSIONS: : In this nonrandomized cohort of patients, occlusion rate with Symmetry connectors was significantly greater than anticipated. Patients who have received these connectors during coronary artery bypass surgery may require closer follow-up and evaluation. While the manufacturer has stopped producing this device, there has been no recall of the product, clinical support remains ongoing, and next generation connectors have now been marketed. Consideration should be given to discontinuation of the clinical use of Symmetry connectors. FAU - Zenati, Marco A AU - Zenati MA AD - *Veterans Affairs Cooperative Studies Program Coordinating Center, VA Maryland, Healthcare System, Perry Point, MD and University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, MD; †VA Pittsburgh Healthcare System and Division of Cardiothoracic Surgery-University of Pittsburgh School of Medicine, Pittsburgh, PA; ‡Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO; §University of South Florida, Tampa General Hospital, James A. Haley Veterans Administration Hospital, Tampa, FL. FAU - Sonel, Ali AU - Sonel A FAU - Hattler, Brack AU - Hattler B FAU - Shroyer, A Laurie AU - Shroyer AL FAU - Collins, Joseph AU - Collins J FAU - Messenger, John AU - Messenger J FAU - Baltz, Janet H AU - Baltz JH FAU - Mohr, Lisa M AU - Mohr LM FAU - Gabany, Jennifer M AU - Gabany JM FAU - Novitsky, Dimitri AU - Novitsky D FAU - Grover, Frederick AU - Grover F LA - eng PT - Journal Article PL - United States TA - Innovations (Phila) JT - Innovations (Philadelphia, Pa.) JID - 101257528 EDAT- 2006/10/01 00:00 MHDA- 2006/10/01 00:01 CRDT- 2012/03/23 06:00 PHST- 2012/03/23 06:00 [entrez] PHST- 2006/10/01 00:00 [pubmed] PHST- 2006/10/01 00:01 [medline] AID - 01243895-200600150-00008 [pii] AID - 10.1097/01.IMI.0000229898.22601.55 [doi] PST - ppublish SO - Innovations (Phila). 2006 Fall;1(5):255-7. doi: 10.1097/01.IMI.0000229898.22601.55. PMID- 11096618 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1523-3839 (Print) IS - 1523-3839 (Linking) VI - 1 IP - 2 DP - 1999 Jul TI - Alternative Approaches to Coronary Revascularization. PG - 138-146 FAU - Cohen, HA AU - Cohen HA AD - Cardiovascular Institute, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA. FAU - Zenati, M AU - Zenati M LA - eng PT - Journal Article PL - United States TA - Curr Interv Cardiol Rep JT - Current interventional cardiology reports JID - 100888981 EDAT- 2000/11/30 00:00 MHDA- 2000/11/30 00:01 CRDT- 2000/11/30 00:00 PHST- 2000/11/30 00:00 [pubmed] PHST- 2000/11/30 00:01 [medline] PHST- 2000/11/30 00:00 [entrez] PST - ppublish SO - Curr Interv Cardiol Rep. 1999 Jul;1(2):138-146. PMID- 10513776 OWN - NLM STAT- MEDLINE DCOM- 19991021 LR - 20190622 IS - 0002-9149 (Print) IS - 0002-9149 (Linking) VI - 84 IP - 7 DP - 1999 Oct 1 TI - Assessment of left internal mammary artery graft patency and flow reserve after minimally invasive direct coronary artery bypass. PG - 795-801 AB - Despite its merits, minimally invasive direct coronary artery bypass surgery (MIDCAB) has been criticized for variable left internal mammary artery (LIMA) graft patency rates, prompting the frequent use of postoperative LIMA angiography. Noninvasive transthoracic Doppler interrogation of LIMA grafts has recently been shown to have utility for assessing patency and flow reserve after conventional bypass surgery, but data after MIDCAB has been limited. The objective of this study was to assess LIMA graft anatomy and physiology in 54 patients after MIDCAB using angiography and noninvasive LIMA Doppler imaging. The right internal mammary artery (RIMA) was studied as a control. LIMA flow reserve in response to adenosine was evaluated in a subgroup of 18 randomly chosen patients with patent grafts. LIMA angiographic patency was 93%. Forty-four patients (81%) had obtainable LIMA Doppler data. Patent grafts had a diastolic dominant flow pattern with a peak diastolic/systolic velocity ratio of 1.3 +/- 0.6 and a percent diastolic time-velocity integral (TVI) of 70 +/- 11%. These data were significantly different than the RIMA control values of 0.2 +/- 0.1 and 30 +/- 10%, respectively (p <0.05). Occluded grafts had absent flow or a systolic dominant pattern. Adenosine-induced increases in LIMA peak diastolic velocity from 48 +/- 20 to 105 +/-28 cm/s (p <0.05 vs baseline) and diastolic TVI from 21 +/- 10 to 37 +/- 19 cm (p <0.05 vs baseline), yielding adenosine/baseline ratios of 2.4 +/- 0.9 and 2.0 +/- 0.7, respectively, which was consistent with normal flow reserve. The diastolic flow velocity reserve response was inversely related to baseline diastolic flow (r = -0.69). In conclusion, MIDCAB can be associated with a high rate of LIMA potency and favorable physiologic Doppler flow patterns. Correlation of these findings to long-term patient outcome after MIDCAB is warranted. FAU - Katz, W E AU - Katz WE AD - Division of Cardiology, University of Pittsburgh, Pennsylvania, USA. katzwe@msx.upmc.edu FAU - Zenati, M AU - Zenati M FAU - Mandarino, W A AU - Mandarino WA FAU - Cohen, H A AU - Cohen HA FAU - Gorcsan, J 3rd AU - Gorcsan J 3rd LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Am J Cardiol JT - The American journal of cardiology JID - 0207277 RN - 0 (Vasodilator Agents) RN - K72T3FS567 (Adenosine) SB - AIM SB - IM MH - Adenosine/administration & dosage MH - Aged MH - Analysis of Variance MH - Blood Flow Velocity MH - Coronary Angiography MH - Coronary Artery Bypass/*methods MH - Coronary Disease/diagnostic imaging/*surgery MH - Coronary Vessels/diagnostic imaging MH - Echocardiography, Doppler MH - Female MH - Humans MH - *Internal Mammary-Coronary Artery Anastomosis MH - Linear Models MH - Male MH - Mammary Arteries/diagnostic imaging MH - Middle Aged MH - Minimally Invasive Surgical Procedures MH - Regional Blood Flow MH - Thoracotomy/methods MH - Vascular Patency MH - Vasodilator Agents/administration & dosage EDAT- 1999/10/08 09:00 MHDA- 2001/03/28 10:01 CRDT- 1999/10/08 09:00 PHST- 1999/10/08 09:00 [pubmed] PHST- 2001/03/28 10:01 [medline] PHST- 1999/10/08 09:00 [entrez] AID - S0002-9149(99)00439-7 [pii] AID - 10.1016/s0002-9149(99)00439-7 [doi] PST - ppublish SO - Am J Cardiol. 1999 Oct 1;84(7):795-801. doi: 10.1016/s0002-9149(99)00439-7. PMID- 10640005 OWN - NLM STAT- MEDLINE DCOM- 20000121 LR - 20191024 IS - 0730-4625 (Print) IS - 0730-4625 (Linking) VI - 18 IP - 2 DP - 1999 Mar-Apr TI - Minimally invasive coronary artery bypass grafting: a kinder cut. PG - 21-3 AB - Minimally invasive coronary artery bypass graft (CABG) surgery is a promising variation on traditional CABG, avoiding the risks of sternotomy and cardiopulmonary bypass. This article describes the procedure, patient-selection criteria, and postoperative care. FAU - Koncsol, K AU - Koncsol K AD - Cardiothoracic Intensive Care Unit, University of Pittsburgh Medical Center, Pa., USA. FAU - DeVoogd, K AU - DeVoogd K FAU - Hravnak, M AU - Hravnak M FAU - Zenati, M AU - Zenati M LA - eng PT - Journal Article PL - United States TA - Dimens Crit Care Nurs JT - Dimensions of critical care nursing : DCCN JID - 8211489 SB - N MH - Coronary Artery Bypass/*methods/nursing MH - Critical Care/*methods MH - Humans MH - Minimally Invasive Surgical Procedures/*methods/nursing MH - Patient Discharge MH - Patient Selection MH - Postoperative Care/*methods EDAT- 2000/01/20 00:00 MHDA- 2000/01/20 00:01 CRDT- 2000/01/20 00:00 PHST- 2000/01/20 00:00 [pubmed] PHST- 2000/01/20 00:01 [medline] PHST- 2000/01/20 00:00 [entrez] AID - 10.1097/00003465-199903000-00004 [doi] PST - ppublish SO - Dimens Crit Care Nurs. 1999 Mar-Apr;18(2):21-3. doi: 10.1097/00003465-199903000-00004. PMID- 1659899 OWN - NLM STAT- MEDLINE DCOM- 19920107 LR - 20171116 IS - 1053-2498 (Print) IS - 1053-2498 (Linking) VI - 10 IP - 5 Pt 1 DP - 1991 Sep-Oct TI - Cytomegalovirus infection and survival in lung transplant recipients. PG - 638-44; discussion 645-6 AB - Fifty-nine patients who survived more than 30 days after lung transplantation (52 heart-lung, seven double lung, and two single lung) were studied for mortality and morbidity related to cytomegalovirus (CMV) infection. CMV infection developed in 32 patients (54%) and was more common in the preoperatively CMV seropositive group (95%) as compared with the seronegative group (38%). Symptomatic infections, pneumonitis, and CMV-related mortality, however, were higher in the seronegative (primary infection) group and actuarial survival was worse in these patients (40% and 23% at 1 and 5 years, respectively). Transplantation of CMV-seropositive donor organs was associated with a significantly higher incidence of primary infection and use of seronegative blood products led to a decrease in the primary CMV infection rate. The mortality of primary CMV infection was 54% and this was associated with a significantly higher rate of pulmonary superinfections in the first year after transplantation. The incidence of late pulmonary infections was associated with the development of chronic rejection rather than CMV status. We conclude that primary CMV infection has a major impact on the outcome after lung transplantation. The high mortality of primary infections justifies an aggressive approach to prevention and treatment in the at-risk seronegative group. FAU - Duncan, A J AU - Duncan AJ AD - Department of Cardiothoracic Surgery, Presbyterian Hospital, University of Pittsburgh, Pa 15261. FAU - Dummer, J S AU - Dummer JS FAU - Paradis, I L AU - Paradis IL FAU - Dauber, J H AU - Dauber JH FAU - Yousem, S A AU - Yousem SA FAU - Zenati, M A AU - Zenati MA FAU - Kormos, R L AU - Kormos RL FAU - Griffith, B P AU - Griffith BP LA - eng PT - Journal Article PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 SB - IM MH - Actuarial Analysis MH - Adolescent MH - Adult MH - Child MH - Child, Preschool MH - Cytomegalovirus Infections/etiology/*mortality MH - Female MH - Heart-Lung Transplantation/mortality MH - Humans MH - Incidence MH - Lung Transplantation/adverse effects/*mortality MH - Male MH - Middle Aged MH - Pneumonia/etiology MH - Postoperative Complications/etiology/*mortality MH - Superinfection/mortality MH - Survival Rate MH - Tissue Donors MH - Transfusion Reaction EDAT- 1991/09/01 00:00 MHDA- 1991/09/01 00:01 CRDT- 1991/09/01 00:00 PHST- 1991/09/01 00:00 [pubmed] PHST- 1991/09/01 00:01 [medline] PHST- 1991/09/01 00:00 [entrez] PST - ppublish SO - J Heart Lung Transplant. 1991 Sep-Oct;10(5 Pt 1):638-44; discussion 645-6. PMID- 21096276 OWN - NLM STAT- MEDLINE DCOM- 20110311 LR - 20200928 IS - 2375-7477 (Print) IS - 2375-7477 (Linking) VI - 2010 DP - 2010 TI - Application of the HeartLander crawling robot for injection of a thermally sensitive anti-remodeling agent for myocardial infarction therapy. PG - 5428-31 LID - 10.1109/IEMBS.2010.5626518 [doi] AB - The injection of a mechanical bulking agent into the left ventricular (LV) wall of the heart has shown promise as a therapy for maladaptive remodeling of the myocardium after myocardial infarct (MI). The HeartLander robotic crawler presented itself as an ideal vehicle for minimally-invasive, highly accurate epicardial injection of such an agent. Use of the optimal bulking agent, a thermosetting hydrogel developed by our group, presents a number of engineering obstacles, including cooling of the miniaturized injection system while the robot is navigating in the warm environment of a living patient. We present herein a demonstration of an integrated miniature cooling and injection system in the HeartLander crawling robot, that is fully biocompatible and capable of multiple injections of a thermosetting hydrogel into dense animal tissue while the entire system is immersed in a 37°C water bath. FAU - Chapman, Michael P AU - Chapman MP AD - Department of General Surgery, Medical College of Georgia, Augusta, GA 30912, USA. FAU - Lopez Gonzalez, Jose L AU - Lopez Gonzalez JL FAU - Goyette, Brina E AU - Goyette BE FAU - Fujimoto, Kazuro L AU - Fujimoto KL FAU - Ma, Zuwei AU - Ma Z FAU - Wagner, William R AU - Wagner WR FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-06/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural 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 RN - 25852-47-5 (Hydrogel, Polyethylene Glycol Dimethacrylate) SB - IM MH - Animals MH - Chickens MH - Hydrogel, Polyethylene Glycol Dimethacrylate/*administration & dosage/*pharmacology MH - Injections MH - Motion MH - Myocardial Infarction/*physiopathology/*therapy MH - Robotics/*instrumentation MH - *Temperature MH - Ventricular Remodeling/*drug effects PMC - PMC3136879 MID - NIHMS288819 EDAT- 2010/11/26 06:00 MHDA- 2011/03/12 06:00 CRDT- 2010/11/25 06:00 PHST- 2010/11/25 06:00 [entrez] PHST- 2010/11/26 06:00 [pubmed] PHST- 2011/03/12 06:00 [medline] AID - 10.1109/IEMBS.2010.5626518 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:5428-31. doi: 10.1109/IEMBS.2010.5626518. PMID- 28211607 OWN - NLM STAT- MEDLINE DCOM- 20180806 LR - 20181201 IS - 1478-596X (Electronic) IS - 1478-5951 (Print) IS - 1478-5951 (Linking) VI - 13 IP - 4 DP - 2017 Dec TI - Physiological motion modeling for organ-mounted robots. LID - 10.1002/rcs.1805 [doi] AB - BACKGROUND: Organ-mounted robots passively compensate heartbeat and respiratory motion. In model-guided procedures, this motion can be a significant source of information that can be used to aid in localization or to add dynamic information to static preoperative maps. METHODS: Models for estimating periodic motion are proposed for both position and orientation. These models are then tested on animal data and optimal orders are identified. Finally, methods for online identification are demonstrated. RESULTS: Models using exponential coordinates and Euler-angle parameterizations are as accurate as models using quaternion representations, yet require a quarter fewer parameters. Models which incorporate more than four cardiac or three respiration harmonics are no more accurate. Finally, online methods estimate model parameters as accurately as offline methods within three respiration cycles. CONCLUSIONS: These methods provide a complete framework for accurately modelling the periodic deformation of points anywhere on the surface of the heart in a closed chest. CI - Copyright © 2017 John Wiley & Sons, Ltd. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, 15213, USA. FAU - Schwartzman, David AU - Schwartzman D AD - Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, 15213, USA. FAU - Zenati, Marco A AU - Zenati MA AD - BHS Department of Cardiothoracic Surgery, Harvard Medical School, West Roxbury, MA, USA. FAU - Riviere, Cameron N AU - Riviere CN AUID- ORCID: 0000-0002-6749-3140 AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, 15213, USA. LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20170217 TA - Int J Med Robot JT - The international journal of medical robotics + computer assisted surgery : MRCAS JID - 101250764 SB - IM MH - Algorithms MH - Animals MH - Equipment Design MH - Fourier Analysis MH - Heart/*physiology MH - *Heart Rate MH - Humans MH - Imaging, Three-Dimensional MH - Internet MH - Models, Biological MH - *Movement MH - Respiration MH - *Robotics MH - Rotation PMC - PMC5561420 MID - NIHMS837309 EDAT- 2017/02/18 06:00 MHDA- 2018/08/07 06:00 CRDT- 2017/02/18 06:00 PHST- 2016/06/27 00:00 [received] PHST- 2016/12/09 00:00 [revised] PHST- 2016/12/11 00:00 [accepted] PHST- 2017/02/18 06:00 [pubmed] PHST- 2018/08/07 06:00 [medline] PHST- 2017/02/18 06:00 [entrez] AID - 10.1002/rcs.1805 [doi] PST - ppublish SO - Int J Med Robot. 2017 Dec;13(4):10.1002/rcs.1805. doi: 10.1002/rcs.1805. Epub 2017 Feb 17. PMID- 24511430 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 2153-0858 (Print) IS - 2153-0866 (Electronic) IS - 2153-0858 (Linking) VI - 2012 DP - 2013 Dec 31 TI - Space-Time Localization and Registration on the Beating Heart. PG - 3792-3797 AB - This paper presents a framework for localizing a miniature epicardial crawling robot, HeartLander, on the beating heart using only 6-degree-of-freedom position measurements from an electromagnetic position tracker and a dynamic surface model of the heart. Using only this information, motion and observation models of the system are developed such that a particle filter can accurately estimate not only the location of the robot on the surface of the heart, but also the pose of the heart in the world coordinate frame as well as the current physiological phase of the heart. The presented framework is then demonstrated in simulation on a dynamic 3-D model of the human heart and a robot motion model which accurately mimics the behavior of the HeartLander robot. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213. FAU - Waugh, Kevin AU - Waugh K AD - Computer Science Department, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213. FAU - Liu, Tian Yu Tommy AU - Liu TY AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213. FAU - Zenati, Marco A AU - Zenati MA AD - BHS Department of Cardiothoracic Surgery, Harvard Medical School, West Roxbury, Massachusetts 02132. FAU - Riviere, Cameron N AU - Riviere CN AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213. LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Rep U S JT - Proceedings of the ... IEEE/RSJ International Conference on Intelligent Robots and Systems. IEEE/RSJ International Conference on Intelligent Robots and Systems JID - 101532742 PMC - PMC3915516 MID - NIHMS410312 EDAT- 2014/02/11 06:00 MHDA- 2014/02/11 06:01 CRDT- 2014/02/11 06:00 PHST- 2014/02/11 06:00 [entrez] PHST- 2014/02/11 06:00 [pubmed] PHST- 2014/02/11 06:01 [medline] AID - 10.1109/IROS.2012.6386009 [doi] PST - ppublish SO - Rep U S. 2013 Dec 31;2012:3792-3797. doi: 10.1109/IROS.2012.6386009. PMID- 23066511 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 2153-0858 (Print) IS - 2153-0866 (Electronic) IS - 2153-0858 (Linking) VI - 2011 DP - 2011 Dec 5 TI - Position Estimation of an Epicardial Crawling Robot on the Beating Heart by Modeling of Physiological Motion. PG - 4522-4527 AB - HeartLander, a small mobile robot designed to provide treatments to the surface of the beating heart, overcomes a major difficulty of minimally invasive cardiac surgery, providing a stable operating platform. This is achieved inherently in the way the robot adheres to and crawls over the surface of the heart. This mode of operation does not require physiological motion compensation to provide this stable environment; however, modeling of physiological motion is advantageous in providing more accurate position estimation as well as synchronization of motion to the physiological cycles. The work presented uses an Extended Kalman Filter framework to estimate parameters of non-stationary Fourier series models of the motion of the heart due to the respiratory and cardiac cycles as well as the position of the robot as it moves over the surface of the heart. The proposed method is demonstrated in the laboratory with HeartLander operating on a physiological motion simulator. Improved performance is demonstrated in comparison to the filtering methods previously used with HeartLander. The use of detected physiological cycle phases to synchronize locomotion of HeartLander is also described. FAU - Wood, Nathan A AU - Wood NA AD - Robotics Institute, Carnegie Mellon University, Pittsburgh, PA 15213 USA. FAU - Del Agua, Diego Moral AU - Del Agua DM FAU - Zenati, Marco A AU - Zenati MA FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-06/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20110925 TA - Rep U S JT - Proceedings of the ... IEEE/RSJ International Conference on Intelligent Robots and Systems. IEEE/RSJ International Conference on Intelligent Robots and Systems JID - 101532742 PMC - PMC3467976 MID - NIHMS346896 EDAT- 2012/10/16 06:00 MHDA- 2012/10/16 06:01 CRDT- 2012/10/16 06:00 PHST- 2012/10/16 06:00 [entrez] PHST- 2012/10/16 06:00 [pubmed] PHST- 2012/10/16 06:01 [medline] AID - 10.1109/IROS.2011.6095084 [doi] PST - ppublish SO - Rep U S. 2011 Dec 5;2011:4522-4527. doi: 10.1109/IROS.2011.6095084. Epub 2011 Sep 25. PMID- 22436750 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20130704 LR - 20120322 IS - 1556-9845 (Print) IS - 1556-9845 (Linking) VI - 1 IP - 5 DP - 2006 Fall TI - Percutaneous subxiphoid access to the epicardium using a miniature crawling robotic device. PG - 227-31 LID - 10.1097/01.IMI.0000240673.14388.fc [doi] AB - BACKGROUND: : To expand minimally invasive beating-heart surgery, we have developed a miniature 2-footed crawling robot (HeartLander) that navigates on the epicardium. This paradigm obviates mechanical stabilization and lung deflation, and avoids the access limitations of current approaches. We tested the locomotion of the device on a beating porcine heart accessed through a closed-chest subxiphoid approach. METHODS: : HeartLander consists of 2 modules that are connected by an extensible midsection. It adheres to the epicardium using suction pads. Locomotion and turning are accomplished by moving the 2 modules in an alternating fashion using wires that run through the midsection between them. After a preliminary test with a plastic beating-heart model, we performed a porcine study in vivo. The device was inserted into the pericardial space through a subxiphoid incision, while the test was observed using a left thoracoscopy. The blood pressure and electrocardiogram were monitored, and vacuum pressure and driving forces on the wires were recorded. RESULTS: : HeartLander traveled across the anterior and lateral surfaces of the beating heart without restriction, including locomotion forward, backward, and turning. The vacuum pressure was kept below 450 mm Hg at all times. The average maximum force during elongation was 1.86 ± 0.97 N, and during retraction was 1.24 ± 0.33 N. No adverse hemodynamic or electrophysiologic events were noted during the trial. No epicardial damage was found on the excised heart after the porcine trial. CONCLUSIONS: : The current HeartLander prototype demonstrated safe and successful locomotion on a beating porcine heart through a closed-chest subxiphoid approach. FAU - Ota, Takeyoshi AU - Ota T AD - From the *Division of Cardiac Surgery, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, PA; †The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA. FAU - Patronik, Nicholas A AU - Patronik NA FAU - Riviere, Cameron N AU - Riviere CN FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PL - United States TA - Innovations (Phila) JT - Innovations (Philadelphia, Pa.) JID - 101257528 EDAT- 2006/10/01 00:00 MHDA- 2006/10/01 00:01 CRDT- 2012/03/23 06:00 PHST- 2012/03/23 06:00 [entrez] PHST- 2006/10/01 00:00 [pubmed] PHST- 2006/10/01 00:01 [medline] AID - 01243895-200600150-00002 [pii] AID - 10.1097/01.IMI.0000240673.14388.fc [doi] PST - ppublish SO - Innovations (Phila). 2006 Fall;1(5):227-31. doi: 10.1097/01.IMI.0000240673.14388.fc. PMID- 15769699 OWN - NLM STAT- MEDLINE DCOM- 20061213 LR - 20141120 IS - 1522-6662 (Electronic) IS - 1098-3511 (Linking) VI - 7 IP - 6 DP - 2004 TI - Prototype epicardial crawling device for intrapericardial intervention on the beating heart. PG - E639-43 AB - The development and preliminary testing of a device for facilitating minimally invasive beating-heart intrapericardial interventions are described. We propose the concept of an endoscopic robotic device that adheres to the epicardium by suction and navigates by crawling like an inchworm to any position on the surface under the control of a surgeon. This approach obviates cardiac stabilization, lung deflation, differential lung ventilation, and reinsertion of laparoscopic tools for accessing different treatment sites, thus offering the possibility of reduced trauma to the patient. The device has a working channel through which various tools can be introduced for treatment. The current prototype demonstrated successful prehension, turning, and locomotion on beating hearts in a limited number of trials in a porcine model. FAU - Riviere, Cameron N AU - Riviere CN AD - The Robotics Institute, Carnegie Mellon University. FAU - Patronik, Nicholas A AU - Patronik NA FAU - Zenati, Marco A AU - Zenati MA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Heart Surg Forum JT - The heart surgery forum JID - 100891112 SB - IM MH - Animals MH - *Endoscopes MH - Equipment Design MH - Equipment Failure Analysis MH - Feasibility Studies MH - Minimally Invasive Surgical Procedures/*instrumentation/methods MH - Motion MH - Pericardiectomy/*instrumentation/methods MH - Pilot Projects MH - Robotics/*instrumentation/methods MH - Swine EDAT- 2005/03/17 09:00 MHDA- 2006/12/14 09:00 CRDT- 2005/03/17 09:00 PHST- 2005/03/17 09:00 [pubmed] PHST- 2006/12/14 09:00 [medline] PHST- 2005/03/17 09:00 [entrez] AID - J4YXRER4J6KQH54L [pii] AID - 10.1532/HSF98.20041057 [doi] PST - ppublish SO - Heart Surg Forum. 2004;7(6):E639-43. doi: 10.1532/HSF98.20041057. PMID- 18824742 OWN - NLM STAT- MEDLINE DCOM- 20081023 LR - 20181113 IS - 1524-4539 (Electronic) IS - 0009-7322 (Print) IS - 0009-7322 (Linking) VI - 118 IP - 14 Suppl DP - 2008 Sep 30 TI - Minimally invasive epicardial injections using a novel semiautonomous robotic device. PG - S115-20 LID - 10.1161/CIRCULATIONAHA.107.756049 [doi] AB - BACKGROUND: We have developed a novel miniature robotic device (HeartLander) that can navigate on the surface of the beating heart through a subxiphoid approach. This study investigates the ability of HeartLander to perform in vivo semiautonomous epicardial injections on the beating heart. METHODS AND RESULTS: The inchworm-like locomotion of HeartLander is generated using vacuum pressure for prehension of the epicardium and drive wires for actuation. The control system enables semiautonomous target acquisition by combining the joystick input with real-time 3-dimensional localization of the robot provided by an electromagnetic tracking system. In 12 porcine preparations, the device was inserted into the intrapericardial space through a subxiphoid approach. Ventricular epicardial injections of dye were performed with a custom injection system through HeartLander's working channel. HeartLander successfully navigated to designated targets located around the circumference of the ventricles (mean path length=51+/-25 mm; mean speed=38+/-26 mm/min). Injections were successfully accomplished following the precise acquisition of target patterns on the left ventricle (mean injection depth=3.0+/-0.5 mm). Semiautonomous target acquisition was achieved within 1.0+/-0.9 mm relative to the reference frame of the tracking system. No fatal arrhythmia or bleeding was noted. There were no histological injuries to the heart due to the robot prehension, locomotion, or injection. CONCLUSIONS: In this proof-of-concept study, HeartLander demonstrated semiautonomous, precise, and safe target acquisition and epicardial injection on a beating porcine heart through a subxiphoid approach. This technique may facilitate minimally invasive cardiac cell transplantation or polymer therapy in patients with heart failure. FAU - Ota, Takeyoshi AU - Ota T AD - Division of Cardiac Surgery, University of Pittsburgh, 200 Lothrop Street, PUH C-700, Pittsburgh, PA 15213, USA. FAU - Patronik, Nicholas A AU - Patronik NA FAU - Schwartzman, David AU - Schwartzman D FAU - Riviere, Cameron N AU - Riviere CN FAU - Zenati, Marco A AU - Zenati MA LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-03/HL/NHLBI NIH HHS/United States GR - R56 HL078839/HL/NHLBI NIH HHS/United States GR - R56 HL078839-04/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. TA - Circulation JT - Circulation JID - 0147763 RN - 0 (Coloring Agents) SB - AIM SB - IM MH - Animals MH - Coloring Agents/administration & dosage MH - Electromagnetic Phenomena MH - Equipment Design MH - Injections/*methods MH - Minimally Invasive Surgical Procedures/*instrumentation MH - Myocardial Contraction MH - *Pericardium MH - Pressure MH - Robotics/*instrumentation MH - Swine MH - Vacuum MH - Xiphoid Bone PMC - PMC2832072 MID - NIHMS177358 EDAT- 2008/10/10 09:00 MHDA- 2008/10/24 09:00 CRDT- 2008/10/10 09:00 PHST- 2008/10/10 09:00 [pubmed] PHST- 2008/10/24 09:00 [medline] PHST- 2008/10/10 09:00 [entrez] AID - 118/14_suppl_1/S115 [pii] AID - 10.1161/CIRCULATIONAHA.107.756049 [doi] PST - ppublish SO - Circulation. 2008 Sep 30;118(14 Suppl):S115-20. doi: 10.1161/CIRCULATIONAHA.107.756049. PMID- 3063570 OWN - NLM STAT- MEDLINE DCOM- 19890303 LR - 20061115 IS - 0046-5968 (Print) IS - 0046-5968 (Linking) VI - 18 IP - 6 DP - 1988 Jun TI - [Elements for an analysis of psychosocial indicators and psychological intervention in heart transplantation]. PG - 479-84 AB - It is now accepted that cardiac transplantation is a viable therapeutic alternative for patients with end-stage heart disease. The most recent data offer a favourable short and medium term prognosis. Retrospective studies suggest that transplantation is associated with a good quality of life and tolerance of the side effects of the medication. Even if cardiac transplantation does not appear to be associated with serious psychological morbidity, it is important to assess the recipient's anxiety, depression, body image and his subjective quality of life, including satisfaction with his family and marital life, to prevent postoperative psychologic distress and enhance the patient's coping abilities. The family is the patient's chief buffer against stress but it is also under stress and needs to be aided through this process. The psychosocial themes that appear prominently at the different stages of the transplant process are somewhat predictable. These can be used to help the patient and family anticipate stress and deal with these issues in a way that enhances mastery of a difficult situation. The heart transplant team faces difficult ethical issues regarding patient selection and informed consent. Public input on these issues is needed, especially since more patients elect to receive heart transplants and the donor supply is likely to remain the same, thereby making donor hearts less available to those who could derive benefit from them. FAU - Zenati, M AU - Zenati M AD - Cattedra di Chirurgia Cardiovascolare dell'Università di Verona. FAU - Morelli, D AU - Morelli D FAU - Fabbri, A AU - Fabbri A FAU - Casarotto, D AU - Casarotto D LA - ita PT - English Abstract PT - Journal Article TT - Elementi per un'analisi degli indicatori psico-sociali e per un intervento psicologico nel trapianto cardiaco. PL - Italy TA - G Ital Cardiol JT - Giornale italiano di cardiologia JID - 1270331 SB - IM MH - Family MH - Follow-Up Studies MH - *Heart Transplantation MH - Humans MH - Patient Compliance MH - Psychology MH - Quality of Life MH - Social Adjustment EDAT- 1988/06/01 00:00 MHDA- 1988/06/01 00:01 CRDT- 1988/06/01 00:00 PHST- 1988/06/01 00:00 [pubmed] PHST- 1988/06/01 00:01 [medline] PHST- 1988/06/01 00:00 [entrez] PST - ppublish SO - G Ital Cardiol. 1988 Jun;18(6):479-84. PMID- 4076708 OWN - NLM STAT- MEDLINE DCOM- 19860214 LR - 20161123 IS - 0046-5968 (Print) IS - 0046-5968 (Linking) VI - 15 IP - 7 DP - 1985 Jul TI - [Cardiac failure due to isolated pulmonary sequestration. Description of a clinical case in the neonatal period]. PG - 725-8 AB - Pulmonary Sequestration is a congenital anomaly rarely seen in the pediatric age. Clinical manifestations commonly appear with a respiratory symptomatology and less frequently with cardiac signs especially in the case of an associated congenital heart disease. In the presented case, isolated Pulmonary Sequestration manifested itself as a congestive heart failure, and a diastolic overloading of the left ventricle. After surgical removal of the Sequestration was demonstrated a normalization of both clinical and haemodynamic findings. FAU - Casarotto, D AU - Casarotto D FAU - Fabbri, A AU - Fabbri A FAU - Motta, A AU - Motta A FAU - Rebonato, M AU - Rebonato M FAU - Zenati, M AU - Zenati M FAU - Consolaro, G AU - Consolaro G LA - ita PT - Case Reports PT - Journal Article TT - Scompenso cardiaco da sequestro polmonare isolato. Descrizione di un caso clinico in età neonatale. PL - Italy TA - G Ital Cardiol JT - Giornale italiano di cardiologia JID - 1270331 SB - IM MH - Bronchopulmonary Sequestration/*complications/diagnostic imaging MH - Heart Failure/*etiology MH - Humans MH - Infant, Newborn MH - Infant, Premature, Diseases/diagnostic imaging MH - Male MH - Radiography EDAT- 1985/07/01 00:00 MHDA- 1985/07/01 00:01 CRDT- 1985/07/01 00:00 PHST- 1985/07/01 00:00 [pubmed] PHST- 1985/07/01 00:01 [medline] PHST- 1985/07/01 00:00 [entrez] PST - ppublish SO - G Ital Cardiol. 1985 Jul;15(7):725-8. PMID- 7776700 OWN - NLM STAT- MEDLINE DCOM- 19950707 LR - 20041117 IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 109 IP - 6 DP - 1995 Jun TI - Infections and pathologic factors in the donor lung. PG - 1263-4 FAU - Dowling, R D AU - Dowling RD FAU - Williams, P AU - Williams P FAU - Zenati, M AU - Zenati M FAU - Griffith, B P AU - Griffith BP FAU - Hardesty, R L AU - Hardesty RL LA - eng PT - Comment PT - Letter PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 RN - 0 (Anti-Bacterial Agents) SB - AIM SB - IM CON - J Thorac Cardiovasc Surg. 1993 Oct;106(4):614-21. PMID: 8412254 MH - Anti-Bacterial Agents/*administration & dosage MH - Humans MH - Lung/microbiology MH - Lung Transplantation/*adverse effects MH - Pneumonia, Bacterial/*prevention & control MH - Postoperative Complications/*prevention & control MH - Tissue Donors EDAT- 1995/06/01 00:00 MHDA- 1995/06/01 00:01 CRDT- 1995/06/01 00:00 PHST- 1995/06/01 00:00 [pubmed] PHST- 1995/06/01 00:01 [medline] PHST- 1995/06/01 00:00 [entrez] AID - S0022-5223(95)70222-9 [pii] AID - 10.1016/S0022-5223(95)70222-9 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 1995 Jun;109(6):1263-4. doi: 10.1016/S0022-5223(95)70222-9. PMID- 17281569 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20080912 LR - 20200309 IS - 1557-170X (Print) IS - 1557-170X (Linking) VI - 2005 DP - 2005 TI - A miniature cable-driven robot for crawling on the heart. PG - 5771-4 AB - This document describes the design and preliminary testing of a cable-driven robot for the purpose of traveling on the surface of the beating heart to administer therapy. This methodology obviates mechanical stabilization and lung deflation, which are typically required during minimally invasive cardiac surgery. Previous versions of the robot have been remotely actuated through push-pull wires, while visual feedback was provided by fiber optic transmission. Although these early models were able to perform locomotion in vivo on porcine hearts, the stiffness of the wire-driven transmission and fiber optic camera limited the mobility of the robots. The new prototype described in this document is actuated by two antagonistic cable pairs, and contains a color CCD camera located in the front section of the device. These modifications have resulted in superior mobility and visual feedback. The cable-driven prototype has successfully demonstrated prehension, locomotion, and tissue dye injection during in vitro testing with a poultry model. FAU - Patronik, N A AU - Patronik NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA. FAU - Zenati, M A AU - Zenati MA FAU - Riviere, C N AU - Riviere CN LA - eng PT - Journal Article PL - United States TA - Conf Proc IEEE Eng Med Biol Soc JT - Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference JID - 101243413 EDAT- 2007/02/07 09:00 MHDA- 2007/02/07 09:01 CRDT- 2007/02/07 09:00 PHST- 2007/02/07 09:00 [pubmed] PHST- 2007/02/07 09:01 [medline] PHST- 2007/02/07 09:00 [entrez] AID - 10.1109/IEMBS.2005.1615799 [doi] PST - ppublish SO - Conf Proc IEEE Eng Med Biol Soc. 2005;2005:5771-4. doi: 10.1109/IEMBS.2005.1615799. PMID- 11520453 OWN - NLM STAT- MEDLINE DCOM- 20011011 LR - 20191105 IS - 1061-5377 (Print) IS - 1061-5377 (Linking) VI - 9 IP - 5 DP - 2001 Sep-Oct TI - Robotic heart surgery. PG - 287-94 AB - Advances in computer and robotic technology are transforming cardiac surgery, overcoming the limitations of conventional endoscopic tools. Using minimal access through 5 millimeter ports, computer-enhanced instruments provide superhuman dexterity through tremor filtration and motion scaling, and are capable of precise manipulation in confined body cavities. Using these technologies, endoscopic beating heart coronary bypass surgery as well as complex mitral valve repairs have been performed in the last few years. However, the current world experience with robotic heart surgery is mostly anecdotal, retrospective, and noncontrolled. Results of rigorous prospective randomized studies in the United States under Food and Drug Administration approved protocols, are awaited. The use of robotic telemanipulation technology for heart surgery is restricted in the United States to patients enrolled in clinical studies in a few elite centers. Further refinement in robotic and image-guided technology for cardiac surgery may further expand the use of computer enhanced instrumentation in the near future. FAU - Zenati, M A AU - Zenati MA AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street Suite C-700, Pittsburgh, PA 15213, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Cardiol Rev JT - Cardiology in review JID - 9304686 SB - IM MH - Cardiac Surgical Procedures/*instrumentation/*trends MH - Heart Diseases/*surgery MH - Humans MH - Patient Care/instrumentation MH - Robotics/*instrumentation RF - 30 EDAT- 2001/08/25 10:00 MHDA- 2001/10/12 10:01 CRDT- 2001/08/25 10:00 PHST- 2001/05/06 00:00 [accepted] PHST- 2001/08/25 10:00 [pubmed] PHST- 2001/10/12 10:01 [medline] PHST- 2001/08/25 10:00 [entrez] AID - 10.1097/00045415-200109000-00009 [doi] PST - ppublish SO - Cardiol Rev. 2001 Sep-Oct;9(5):287-94. doi: 10.1097/00045415-200109000-00009. PMID- 10745509 OWN - NLM STAT- MEDLINE DCOM- 20050516 LR - 20161124 IS - 1042-3931 (Print) IS - 1042-3931 (Linking) VI - 11 IP - 3 DP - 1999 Mar TI - Integrated coronary revascularization. PG - 184-90; discussion 190-1 FAU - Cohen, H A AU - Cohen HA AD - University of Pittsburgh Medical Center, Pennsylvania, USA. FAU - Zenati, M AU - Zenati M LA - eng PT - Case Reports PT - Journal Article PT - Review PL - United States TA - J Invasive Cardiol JT - The Journal of invasive cardiology JID - 8917477 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Angioplasty, Balloon, Coronary/*methods MH - Clinical Trials as Topic MH - Coronary Angiography MH - Coronary Artery Bypass/*methods MH - Coronary Artery Disease/diagnostic imaging/*therapy MH - Female MH - Humans MH - Male MH - Myocardial Revascularization/*methods RF - 9 EDAT- 2000/04/04 00:00 MHDA- 2005/05/17 09:00 CRDT- 2000/04/04 00:00 PHST- 2000/04/04 00:00 [pubmed] PHST- 2005/05/17 09:00 [medline] PHST- 2000/04/04 00:00 [entrez] PST - ppublish SO - J Invasive Cardiol. 1999 Mar;11(3):184-90; discussion 190-1. PMID- 8031822 OWN - NLM STAT- MEDLINE DCOM- 19940812 LR - 20131121 IS - 1053-2498 (Print) IS - 1053-2498 (Linking) VI - 13 IP - 2 DP - 1994 Mar-Apr TI - Successful treatment of disseminated infection with Listeria monocytogenes in a heart transplant recipient. PG - 345-6 FAU - Zenati, M AU - Zenati M FAU - Milano, A AU - Milano A FAU - Livi, U AU - Livi U FAU - Cattelan, A AU - Cattelan A FAU - Casarotto, D AU - Casarotto D LA - eng PT - Case Reports PT - Letter PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 RN - 4O5J85GJJB (Netilmicin) RN - 7C782967RD (Ampicillin) SB - IM MH - Ampicillin/*administration & dosage MH - Cardiomyopathy, Dilated/drug therapy/immunology MH - Drug Therapy, Combination/therapeutic use MH - Heart Transplantation/*immunology MH - Humans MH - *Listeria monocytogenes/immunology MH - Male MH - Meningitis, Listeria/*drug therapy/immunology MH - Middle Aged MH - Netilmicin/*administration & dosage MH - Opportunistic Infections/*drug therapy/immunology MH - Postoperative Complications/*drug therapy/immunology EDAT- 1994/03/01 00:00 MHDA- 1994/03/01 00:01 CRDT- 1994/03/01 00:00 PHST- 1994/03/01 00:00 [pubmed] PHST- 1994/03/01 00:01 [medline] PHST- 1994/03/01 00:00 [entrez] PST - ppublish SO - J Heart Lung Transplant. 1994 Mar-Apr;13(2):345-6. PMID- 24634894 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2155-1774 (Print) IS - 2155-1774 (Linking) VI - 2012 DP - 2012 Dec 31 TI - Toward Onboard Estimation of Physiological Phase for an Epicardial Crawling Robot. PG - 6290716 AB - HeartLander is a miniature mobile robot which adheres to and crawls over the surface of the beating heart to provide therapies in a minimally invasive manner. Although HeartLander inherently provides a stable operating platform, the motion of the surface of the heart remains an important factor in the operation of the robot. The quasi-periodic motion of the heart due to physiological cycles, respiration and the heartbeat, affects the ability of the robot to move, as well as localize accurately. In order to improve locomotion efficiency, as well as register different locations on the heart in physiological phase, two methods of identifying physiological phases are presented: sliding-window-based and model-based. In the sliding-window-based approach a vector of previous measurements is compared to previously learned motion templates to determine the current physiological phases, while the model-based approach learns a Fourier series model of the motion, and uses this model to estimate the current physiological phases using an Extended Kalman Filter (EKF). The two methods, while differing in approach, produce similarly accurate results on data recorded from animal experiments in vivo. FAU - Wood, Nathan A AU - Wood NA AD - The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213. FAU - Schwartzman, David AU - Schwartzman D AD - Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213. FAU - Zenati, Marco A AU - Zenati MA AD - BHS Department of Cardiothoracic Surgery, Harvard Medical School, West Roxbury, Massachusetts 02132. FAU - Riviere, Cameron N AU - Riviere CN LA - eng GR - R01 HL078839/HL/NHLBI NIH HHS/United States GR - R01 HL078839-06/HL/NHLBI NIH HHS/United States GR - R01 HL105911/HL/NHLBI NIH HHS/United States GR - R01 HL105911-03/HL/NHLBI NIH HHS/United States GR - R01 HL105911-02/HL/NHLBI NIH HHS/United States PT - Journal Article TA - Proc IEEE RAS EMBS Int Conf Biomed Robot Biomechatron JT - Proceedings of the ... IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics. IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics JID - 101521127 PMC - PMC3951092 MID - NIHMS368432 EDAT- 2012/12/31 00:00 MHDA- 2012/12/31 00:01 CRDT- 2014/03/18 06:00 PHST- 2014/03/18 06:00 [entrez] PHST- 2012/12/31 00:00 [pubmed] PHST- 2012/12/31 00:01 [medline] AID - 10.1109/BioRob.2012.6290716 [doi] PST - ppublish SO - Proc IEEE RAS EMBS Int Conf Biomed Robot Biomechatron. 2012 Dec 31;2012:6290716. doi: 10.1109/BioRob.2012.6290716. PMID- 11956133 OWN - NLM STAT- MEDLINE DCOM- 20020425 LR - 20190623 IS - 1524-4539 (Electronic) IS - 0009-7322 (Linking) VI - 105 IP - 15 DP - 2002 Apr 16 TI - Images in cardiovascular medicine. Fulminant Clostridium septicum aortitis. PG - 1871 FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa 15213, USA. zenatim@msx.upmc.edu FAU - Bonanomi, Gianluca AU - Bonanomi G FAU - Kostov, Dean AU - Kostov D FAU - Lee, Robert AU - Lee R LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Circulation JT - Circulation JID - 0147763 SB - AIM SB - IM MH - Aged MH - Aorta, Thoracic/diagnostic imaging/microbiology/pathology MH - Aortitis/*diagnosis/*microbiology MH - *Clostridium/isolation & purification MH - Humans MH - Male MH - Tomography, X-Ray Computed EDAT- 2002/04/17 10:00 MHDA- 2002/04/26 10:01 CRDT- 2002/04/17 10:00 PHST- 2002/04/17 10:00 [pubmed] PHST- 2002/04/26 10:01 [medline] PHST- 2002/04/17 10:00 [entrez] AID - 10.1161/01.cir.0000016163.45584.a1 [doi] PST - ppublish SO - Circulation. 2002 Apr 16;105(15):1871. doi: 10.1161/01.cir.0000016163.45584.a1. PMID- 23789699 OWN - NLM STAT- MEDLINE DCOM- 20130925 LR - 20161125 IS - 1546-3141 (Electronic) IS - 0361-803X (Linking) VI - 201 IP - 1 DP - 2013 Jul TI - Static and cine CT imaging to identify and characterize mediastinal adhesions as a potential complication for patients underdoing "redo sternotomy". PG - W72-4 LID - 10.2214/AJR.12.9406 [doi] AB - OBJECTIVE: The purpose of this article is to describe the image acquisition, identification, and reporting of postoperative adhesions in patients undergoing CT for "redo sternotomy" surgical planning. CONCLUSION: Adhesions appear as linear fibrous bands that join structures in the mediastinum viewed on static images. Confirmation by cine imaging shows deformation of mediastinal structures. Identification and reporting of adhesions will likely guide surgeons to safer interventions. FAU - Malguria, Nagina AU - Malguria N AD - Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. nmalguria@gmail.com FAU - Hanley, Michael AU - Hanley M FAU - Steigner, Michael AU - Steigner M FAU - Kumamaru, Kanako K AU - Kumamaru KK FAU - Wake, Nicole AU - Wake N FAU - Zenati, Marco AU - Zenati M FAU - Rybicki, Frank J AU - Rybicki FJ LA - eng PT - Journal Article PL - United States TA - AJR Am J Roentgenol JT - AJR. American journal of roentgenology JID - 7708173 SB - AIM SB - IM MH - Aged MH - Heart Diseases/*surgery MH - Humans MH - Male MH - Mediastinal Diseases/*diagnostic imaging MH - Middle Aged MH - Postoperative Complications/*diagnostic imaging MH - Radiographic Image Interpretation, Computer-Assisted MH - Reoperation MH - *Sternotomy MH - Tissue Adhesions/*diagnostic imaging MH - Tomography, X-Ray Computed/*methods EDAT- 2013/06/26 06:00 MHDA- 2013/09/26 06:00 CRDT- 2013/06/25 06:00 PHST- 2013/06/25 06:00 [entrez] PHST- 2013/06/26 06:00 [pubmed] PHST- 2013/09/26 06:00 [medline] AID - 10.2214/AJR.12.9406 [doi] PST - ppublish SO - AJR Am J Roentgenol. 2013 Jul;201(1):W72-4. doi: 10.2214/AJR.12.9406. PMID- 7488789 OWN - NLM STAT- MEDLINE DCOM- 19960104 LR - 20190920 IS - 0886-0440 (Print) IS - 0886-0440 (Linking) VI - 10 IP - 5 DP - 1995 Sep TI - Surgical management of mobile aortic atheroma diagnosed by intraoperative transesophageal echocardiography. PG - 608-10 FAU - Zenati, M AU - Zenati M FAU - Madia, C L AU - Madia CL FAU - De Nino, L A AU - De Nino LA FAU - Payne, D N AU - Payne DN LA - eng PT - Case Reports PT - Letter PL - United States TA - J Card Surg JT - Journal of cardiac surgery JID - 8908809 SB - IM MH - Aged MH - Aortic Diseases/*diagnostic imaging/*surgery MH - Arteriosclerosis/*diagnostic imaging/*surgery MH - Calcinosis/diagnostic imaging/surgery MH - Coronary Disease/surgery MH - *Echocardiography, Transesophageal MH - Humans MH - *Intraoperative Care MH - Male MH - Myocardial Revascularization MH - Saphenous Vein/transplantation MH - *Ultrasonography, Interventional EDAT- 1995/09/01 00:00 MHDA- 1995/09/01 00:01 CRDT- 1995/09/01 00:00 PHST- 1995/09/01 00:00 [pubmed] PHST- 1995/09/01 00:01 [medline] PHST- 1995/09/01 00:00 [entrez] AID - 10.1111/j.1540-8191.1995.tb00643.x [doi] PST - ppublish SO - J Card Surg. 1995 Sep;10(5):608-10. doi: 10.1111/j.1540-8191.1995.tb00643.x. PMID- 23892939 OWN - NLM STAT- MEDLINE DCOM- 20140311 LR - 20130729 IS - 1535-2811 (Electronic) IS - 1535-2811 (Linking) VI - 12 IP - 3 DP - 2013 Sep TI - Evaluation and management of the atrial fibrillation patient: a report from the Society of Cardiovascular Patient Care. PG - 107-15 LID - 10.1097/HPC.0b013e31829834ed [doi] AB - Atrial fibrillation (AF) is the most common cardiac dysrhythmia, and its prevalence is growing. The care of patients with AF is complex and involves multiple specialties and venues of care. Guideline recommendations are available for AF therapy; however, their implementation can be challenging. The Society of Cardiovascular Patient Care has developed an accreditation program, formulated by an expert committee on AF. Accreditation is based on specific criteria in 7 domains: (1) community outreach, (2) prehospital care, (3) early stabilization, (4) acute care, (5) transitions of care, (6) clinical quality measures, and (7) governance. This document presents the rationale, discussion, and supporting evidence for these criteria, in an effort to maximize effective and efficient AF care. FAU - Steinberg, Benjamin A AU - Steinberg BA AD - Duke University Medical Center, Durham, NC, USA. FAU - Beckley, Philip D AU - Beckley PD FAU - Deering, Thomas F AU - Deering TF FAU - Clark, Carol L AU - Clark CL FAU - Amin, Alpesh N AU - Amin AN FAU - Bauer, Kenneth A AU - Bauer KA FAU - Cryer, Byron AU - Cryer B FAU - Mansour, Moussa AU - Mansour M FAU - Scheiman, James M AU - Scheiman JM FAU - Zenati, Marco A AU - Zenati MA FAU - Newby, L Kristin AU - Newby LK FAU - Peacock, W Frank AU - Peacock WF FAU - Bhatt, Deepak L AU - Bhatt DL CN - Society of Cardiovascular Patient Care LA - eng PT - Journal Article PT - Practice Guideline PL - United States TA - Crit Pathw Cardiol JT - Critical pathways in cardiology JID - 101165286 RN - 0 (Anticoagulants) SB - IM MH - Accreditation/standards MH - Anticoagulants/*therapeutic use MH - Atrial Fibrillation/complications/diagnosis/*therapy MH - Continuity of Patient Care MH - Critical Care/*standards MH - Critical Pathways MH - Hemorrhage/chemically induced MH - Humans MH - Quality of Health Care MH - Thromboembolism/*prevention & control EDAT- 2013/07/31 06:00 MHDA- 2014/03/13 06:00 CRDT- 2013/07/30 06:00 PHST- 2013/07/30 06:00 [entrez] PHST- 2013/07/31 06:00 [pubmed] PHST- 2014/03/13 06:00 [medline] AID - 00132577-201309000-00001 [pii] AID - 10.1097/HPC.0b013e31829834ed [doi] PST - ppublish SO - Crit Pathw Cardiol. 2013 Sep;12(3):107-15. doi: 10.1097/HPC.0b013e31829834ed. PMID- 2198551 OWN - NLM STAT- MEDLINE DCOM- 19900905 LR - 20061115 IS - 0391-5387 (Print) IS - 0391-5387 (Linking) VI - 12 IP - 1 DP - 1990 Jan-Feb TI - [Psycho-affective and relational aspects of children with congenital cardiopathy]. PG - 81-4 AB - The psychological and relational problems present in pediatric patients with congenital cardiac anomalies and in their families are reviewed based on an analysis of the current literature and on the personal experience of the authors. The need for all caretakers, especially the cardiologist and the cardiac surgeon, to be aware of these critical aspects is emphasized. The psychological experience of the patient and of his family is thoroughly addressed. Moreover, the complex relationship that developed between the family and the physician as a result of the family's expectations, requests and unconscious projections are discussed. FAU - Russo, E AU - Russo E AD - Divisione di Pediatria, USSL 46 Castiglione delle Stiviere MN, Italia. FAU - Zenati, M AU - Zenati M FAU - Morelli, D AU - Morelli D FAU - Beduschi, M AU - Beduschi M FAU - Casarotto, D AU - Casarotto D LA - ita PT - English Abstract PT - Journal Article PT - Review TT - Aspetti psico-affettivi e relazionali nei bambini affetti da cardiopatia congenita. PL - Italy TA - Pediatr Med Chir JT - La Pediatria medica e chirurgica : Medical and surgical pediatrics JID - 8100625 SB - IM EIN - Pediatr Med Chir 1990 May-Jun;12(3):308. Marelli D [corrected to Morelli D]; Casarotti D [corrected to Casarotto D] MH - Adolescent MH - Child MH - Child, Preschool MH - Heart Defects, Congenital/*psychology MH - Humans MH - Infant MH - Infant, Newborn MH - *Mother-Child Relations MH - Parent-Child Relations MH - *Physician-Patient Relations RF - 19 EDAT- 1990/01/01 00:00 MHDA- 1990/01/01 00:01 CRDT- 1990/01/01 00:00 PHST- 1990/01/01 00:00 [pubmed] PHST- 1990/01/01 00:01 [medline] PHST- 1990/01/01 00:00 [entrez] PST - ppublish SO - Pediatr Med Chir. 1990 Jan-Feb;12(1):81-4. PMID- 3340435 OWN - NLM STAT- MEDLINE DCOM- 19880226 LR - 20190828 IS - 0301-0449 (Print) IS - 0301-0449 (Linking) VI - 18 IP - 1 DP - 1988 TI - Acro-mesomelic dysplasia--a new type. Report of two siblings. PG - 67-9 AB - Two siblings who represent a new type of acro-mesomelic dysplasia are reported. The unique pattern of the acro-mesomelic hypoplastic/dysplastic changes allows us to designate them as a new syndrome. FAU - Brahimi, L AU - Brahimi L AD - Centre Medico-Pedagogique pour Handicapes Moteur, El-Harrach, Alger, Algeria. FAU - Bacha, L AU - Bacha L FAU - Kozlowski, K AU - Kozlowski K FAU - Massen, R AU - Massen R FAU - Zenati, M AU - Zenati M LA - eng PT - Case Reports PT - Journal Article PL - Germany TA - Pediatr Radiol JT - Pediatric radiology JID - 0365332 SB - IM MH - Child MH - Female MH - Humans MH - Male MH - Osteochondrodysplasias/diagnostic imaging/*genetics MH - Radiography MH - Syndrome EDAT- 1988/01/01 00:00 MHDA- 1988/01/01 00:01 CRDT- 1988/01/01 00:00 PHST- 1988/01/01 00:00 [pubmed] PHST- 1988/01/01 00:01 [medline] PHST- 1988/01/01 00:00 [entrez] AID - 10.1007/BF02395764 [doi] PST - ppublish SO - Pediatr Radiol. 1988;18(1):67-9. doi: 10.1007/BF02395764. PMID- 33327770 OWN - NLM STAT- Publisher LR - 20201230 IS - 1547-8181 (Electronic) IS - 0018-7208 (Linking) DP - 2020 Dec 16 TI - Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists' Interactions With the Cardiopulmonary Bypass Pump. PG - 18720820976297 LID - 10.1177/0018720820976297 [doi] AB - OBJECTIVE: This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. BACKGROUND: Estimations of operators' cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient's homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. METHOD: HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists (N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. RESULTS: Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. CONCLUSION: We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. APPLICATION: These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement. FAU - Kennedy-Metz, Lauren R AU - Kennedy-Metz LR AUID- ORCID: 0000-0002-2696-3943 AD - 20028 VA Boston Healthcare System, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. FAU - Dias, Roger D AU - Dias RD AD - Harvard Medical School, Boston, Massachusetts, USA. FAU - Srey, Rithy AU - Srey R AD - 20028 VA Boston Healthcare System, Massachusetts, USA. FAU - Rance, Geoffrey C AU - Rance GC AD - 20028 VA Boston Healthcare System, Massachusetts, USA. FAU - Conboy, Heather M AU - Conboy HM AD - 14707 University of Massachusetts, Amherst, USA. FAU - Haime, Miguel E AU - Haime ME AD - 20028 VA Boston Healthcare System, Massachusetts, USA. FAU - Quin, Jacquelyn A AU - Quin JA AD - 20028 VA Boston Healthcare System, Massachusetts, USA. FAU - Yule, Steven J AU - Yule SJ AD - Harvard Medical School, Boston, Massachusetts, USA. AD - 1861 University of Edinburgh, Scotland. FAU - Zenati, Marco A AU - Zenati MA AD - 20028 VA Boston Healthcare System, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20201216 PL - United States TA - Hum Factors JT - Human factors JID - 0374660 SB - IM SB - S OTO - NOTNLM OT - patient safety OT - physiological measurement OT - physiological psychology OT - surgical care and procedural technologies OT - wearable devices EDAT- 2020/12/18 06:00 MHDA- 2020/12/18 06:00 CRDT- 2020/12/17 05:28 PHST- 2020/12/17 05:28 [entrez] PHST- 2020/12/18 06:00 [pubmed] PHST- 2020/12/18 06:00 [medline] AID - 10.1177/0018720820976297 [doi] PST - aheadofprint SO - Hum Factors. 2020 Dec 16:18720820976297. doi: 10.1177/0018720820976297. PMID- 33227967 OWN - NLM STAT- In-Process LR - 20210115 IS - 1424-8220 (Electronic) IS - 1424-8220 (Linking) VI - 20 IP - 22 DP - 2020 Nov 19 TI - Sensors for Continuous Monitoring of Surgeon's Cognitive Workload in the Cardiac Operating Room. LID - 10.3390/s20226616 [doi] LID - 6616 AB - Monitoring healthcare providers' cognitive workload during surgical procedures can provide insight into the dynamic changes of mental states that may affect patient clinical outcomes. The role of cognitive factors influencing both technical and non-technical skill are increasingly being recognized, especially as the opportunities to unobtrusively collect accurate and sensitive data are improving. Applying sensors to capture these data in a complex real-world setting such as the cardiac surgery operating room, however, is accompanied by myriad social, physical, and procedural constraints. The goal of this study was to investigate the feasibility of overcoming logistical barriers in order to effectively collect multi-modal psychophysiological inputs via heart rate (HR) and near-infrared spectroscopy (NIRS) acquisition in the real-world setting of the operating room. The surgeon was outfitted with HR and NIRS sensors during aortic valve surgery, and validation analysis was performed to detect the influence of intra-operative events on cardiovascular and prefrontal cortex changes. Signals collected were significantly correlated and noted intra-operative events and subjective self-reports coincided with observable correlations among cardiovascular and cerebral activity across surgical phases. The primary novelty and contribution of this work is in demonstrating the feasibility of collecting continuous sensor data from a surgical team member in a real-world setting. FAU - Kennedy-Metz, Lauren R AU - Kennedy-Metz LR AUID- ORCID: 0000-0002-2696-3943 AD - Division of Cardiac Surgery, Medical Robotics and Computer Assisted Surgery Lab, VA Boston Healthcare System, West Roxbury, MA 02132, USA. AD - Department of Surgery, Harvard Medical School, Boston, MA 02115, USA. FAU - Dias, Roger D AU - Dias RD AUID- ORCID: 0000-0003-4959-5052 AD - STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. FAU - Srey, Rithy AU - Srey R AD - Division of Cardiac Surgery, VA Boston Healthcare System, West Roxbury, MA 02132, USA. FAU - Rance, Geoffrey C AU - Rance GC AD - Division of Cardiac Surgery, VA Boston Healthcare System, West Roxbury, MA 02132, USA. FAU - Furlanello, Cesare AU - Furlanello C AD - HK3 Lab, 20129 Milan, Italy. FAU - Zenati, Marco A AU - Zenati MA AUID- ORCID: 0000-0001-7139-0323 AD - Division of Cardiac Surgery, Medical Robotics and Computer Assisted Surgery Lab, VA Boston Healthcare System, West Roxbury, MA 02132, USA. AD - Department of Surgery, Harvard Medical School, Boston, MA 02115, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States GR - R01HL126896/NH/NIH HHS/United States PT - Letter DEP - 20201119 TA - Sensors (Basel) JT - Sensors (Basel, Switzerland) JID - 101204366 SB - IM PMC - PMC7699221 OTO - NOTNLM OT - cardiac surgery OT - cognitive workload OT - heart rate OT - near-infrared spectroscopy COIS- The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. EDAT- 2020/11/25 06:00 MHDA- 2020/11/25 06:00 CRDT- 2020/11/24 01:06 PHST- 2020/10/15 00:00 [received] PHST- 2020/11/12 00:00 [revised] PHST- 2020/11/16 00:00 [accepted] PHST- 2020/11/24 01:06 [entrez] PHST- 2020/11/25 06:00 [pubmed] PHST- 2020/11/25 06:00 [medline] AID - s20226616 [pii] AID - sensors-20-06616 [pii] AID - 10.3390/s20226616 [doi] PST - epublish SO - Sensors (Basel). 2020 Nov 19;20(22):6616. doi: 10.3390/s20226616. PMID- 33160616 OWN - NLM STAT- Publisher LR - 20201230 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) DP - 2020 Jul 13 TI - Commentary: The need for emotional intelligence coaching in cardiothoracic surgery. LID - S0022-5223(20)32059-6 [pii] LID - 10.1016/j.jtcvs.2020.06.111 [doi] FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, Mass; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: Marco_Zenati@hms.harvard.edu. FAU - Megighian, Chiara H AU - Megighian CH AD - International Coaching Federation, Lexington, Ky. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Editorial DEP - 20200713 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - AIM SB - IM EDAT- 2020/11/09 06:00 MHDA- 2020/11/09 06:00 CRDT- 2020/11/08 20:24 PHST- 2020/06/17 00:00 [received] PHST- 2020/06/17 00:00 [revised] PHST- 2020/06/17 00:00 [accepted] PHST- 2020/11/08 20:24 [entrez] PHST- 2020/11/09 06:00 [pubmed] PHST- 2020/11/09 06:00 [medline] AID - S0022-5223(20)32059-6 [pii] AID - 10.1016/j.jtcvs.2020.06.111 [doi] PST - aheadofprint SO - J Thorac Cardiovasc Surg. 2020 Jul 13:S0022-5223(20)32059-6. doi: 10.1016/j.jtcvs.2020.06.111. PMID- 32989966 OWN - NLM STAT- In-Process LR - 20201230 IS - 1827-1618 (Electronic) IS - 0026-4725 (Linking) VI - 68 IP - 5 DP - 2020 Oct TI - Artificial intelligence in cardiothoracic surgery. PG - 532-538 LID - 10.23736/S0026-4725.20.05235-4 [doi] AB - The tremendous and rapid technological advances that humans have achieved in the last decade have definitely impacted how surgical tasks are performed in the operating room (OR). As a high-tech work environment, the contemporary OR has incorporated novel computational systems into the clinical workflow, aiming to optimize processes and support the surgical team. Artificial intelligence (AI) is increasingly important for surgical decision making to help address diverse sources of information, such as patient risk factors, anatomy, disease natural history, patient values and cost, and assist surgeons and patients to make better predictions regarding the consequences of surgical decisions. In this review, we discuss the current initiatives that are using AI in cardiothoracic surgery and surgical care in general. We also address the future of AI and how high-tech ORs will leverage human-machine teaming to optimize performance and enhance patient safety. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Center for Medical Simulation, Brigham Health, Boston, MA, USA - rdias@bwh.harvard.edu. AD - Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA - rdias@bwh.harvard.edu. FAU - Shah, Julie A AU - Shah JA AD - Laboratory of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA. FAU - Zenati, Marco A AU - Zenati MA AD - Laboratory of Medical Robotics and Computer Assisted Surgery (MRCAS), Division of Cardiothoracic Surgery, VA Boston Healthcare System, Boston, MA, USA. AD - Department of Surgery, Harvard Medical School, Boston, MA, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20200929 PL - Italy TA - Minerva Cardioangiol JT - Minerva cardioangiologica JID - 0400725 SB - IM EDAT- 2020/09/30 06:00 MHDA- 2020/09/30 06:00 CRDT- 2020/09/29 05:49 PHST- 2020/09/30 06:00 [pubmed] PHST- 2020/09/30 06:00 [medline] PHST- 2020/09/29 05:49 [entrez] AID - S0026-4725.20.05235-4 [pii] AID - 10.23736/S0026-4725.20.05235-4 [doi] PST - ppublish SO - Minerva Cardioangiol. 2020 Oct;68(5):532-538. doi: 10.23736/S0026-4725.20.05235-4. Epub 2020 Sep 29. PMID- 32938323 OWN - NLM STAT- In-Process LR - 20210206 IS - 1553-3514 (Electronic) IS - 1553-3506 (Print) IS - 1553-3506 (Linking) VI - 27 IP - 6 DP - 2020 Dec TI - Surgery Task Load Index in Cardiac Surgery: Measuring Cognitive Load Among Teams. PG - 602-607 LID - 10.1177/1553350620934931 [doi] AB - Background. The most commonly used subjective assessment of perceived cognitive load, the NASA Task Load Index (TLX), has proven valuable in measuring individual load among general populations. The surgery task load index (SURG-TLX) was developed and validated to measure cognitive load specifically among individuals within a surgical team. Notably, the TLX lacks temporal sensitivity in its typical retrospective administration. Objective. This study sought to expand the utility of SURG-TLX by investigating individual measures of cognitive load over time during cardiac surgery, and the relationship between individual and team measures of cognitive load and proxies for surgical complexity. Materials & Methods. SURG-TLX was administered retrospectively in the operating room immediately following each case to approximate cognitive load before, during, and after cardiopulmonary bypass for cardiac surgery team members (surgeon, anesthesiologist, and perfusionist). Correlations were calculated to determine the relationship of individual and team measures of cognitive load over the entire procedure with bypass length and surgery length. Results. Results suggest that perceived cognitive load varies throughout the procedure such that cognitive load during bypass significantly differs compared to before or after bypass, across all 3 roles. While on bypass, results show that anesthesiologists experience significantly lower levels of perceived cognitive load than both surgeons and perfusionists. Correlational analyses reveal that perceived cognitive load of both the surgeon and the team had significant positive associations with bypass length and surgery length. Conclusion. Our findings support the utility of SURG-TLX in real cardiac cases as a measure of cognitive load over time, and on an individual and team-wide basis. FAU - Kennedy-Metz, Lauren R AU - Kennedy-Metz LR AUID- ORCID: 0000-0002-2696-3943 AD - Division of Cardiac Surgery, 20028Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA. AD - Department of Surgery, 1811Harvard Medical School, Boston, MA, USA. FAU - Wolfe, Hill L AU - Wolfe HL AUID- ORCID: 0000-0001-8834-1560 AD - 27118Boston University School of Public Health, Boston, MA, USA. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Center for Medical Simulation, 1861Brigham and Women's Hospital, Boston, MA, USA. AD - Department of Emergency Medicine, 1811Harvard Medical School, Boston, MA, USA. FAU - Yule, Steven J AU - Yule SJ AD - Department of Surgery, 1811Harvard Medical School, Boston, MA, USA. AD - 3124The University of Edinburgh, Scotland. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, 20028Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA. AD - Department of Surgery, 1811Harvard Medical School, Boston, MA, USA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20200617 TA - Surg Innov JT - Surgical innovation JID - 101233809 SB - IM PMC - PMC7744397 MID - NIHMS1604604 OTO - NOTNLM OT - cardiac surgery OT - cognitive load OT - surgery task load index COIS- Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2020/09/18 06:00 MHDA- 2020/09/18 06:00 CRDT- 2020/09/17 05:30 PHST- 2020/09/18 06:00 [pubmed] PHST- 2020/09/18 06:00 [medline] PHST- 2020/09/17 05:30 [entrez] AID - 10.1177/1553350620934931 [doi] PST - ppublish SO - Surg Innov. 2020 Dec;27(6):602-607. doi: 10.1177/1553350620934931. Epub 2020 Jun 17. PMID- 32863172 OWN - NLM STAT- Publisher LR - 20200831 IS - 1878-7452 (Electronic) IS - 1878-7452 (Linking) DP - 2020 Aug 27 TI - Analysis of Mirrored Psychophysiological Change of Cardiac Surgery Team Members During Open Surgery. LID - S1931-7204(20)30309-3 [pii] LID - 10.1016/j.jsurg.2020.08.012 [doi] AB - OBJECTIVE: Mirrored psychophysiological change in cognitive workload indices may reflect shared mental models and effective healthcare team dynamics. In this exploratory analysis, we investigated the frequency of mirrored changes, defined as concurrent peaks in heart rate variability (HRV) across team members, during cardiac surgery. DESIGN: Objective cognitive workload was evaluated via HRV collected from the primary surgical team during cardiac surgery cases (N = 15). Root mean square of the successive differences (RMSSD) was calculated as the primary HRV measure. Procedures were divided into consecutive nonoverlapping 5-minute segments, and RMSSD along with deviations from RMSSD were calculated for each segment. Segments with positive deflections represent above-average cognitive workload. Positive deflections and peaks across dyads within the same segment were counted. SETTING: Data collection for this study took place in the cardiovascular operating room during live surgeries. PARTICIPANTS: Physiological data were collected and analyzed from the attending surgeon, attending anesthesiologist, and primary perfusionist involved with the recorded cases. RESULTS: Of the 641 five-minute segments analyzed, 325 (50.7%) were positive deflections above average, concurrently across at least 2 team members. Within the 325 positive deflections, 26 (8%) represented concurrent peaks in HRV across at least 2 active team members. Mirrored peaks across team members were observed most commonly during the coronary anastomoses or valve replacement phase (N = 12). CONCLUSIONS: In this pilot study, mirrored physiological responses representing peaks in cognitive workload were observed uncommonly across dyads of cardiac surgery team members (1.73 peaks/case on average). Almost half of these occurred during the most technically demanding phases of cardiac surgery, which may underpin teamwork quality. Future work should investigate interactions between technical and nontechnical performance surrounding times of mirrored peaks and expand the sample size. CI - Copyright © 2020 Association of Program Directors in Surgery. All rights reserved. FAU - Kennedy-Metz, Lauren R AU - Kennedy-Metz LR AD - Medical Robotics and Computer-Assisted Surgery Laboratory, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: Lauren.Kennedy-Metz@va.gov. FAU - Dias, Roger D AU - Dias RD AD - Harvard Medical School, Boston, Massachusetts; STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts. FAU - Stevens, Ronald H AU - Stevens RH AD - Brain Research Institute, Los Angeles, California. FAU - Yule, Steven J AU - Yule SJ AD - Harvard Medical School, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland; Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts. FAU - Zenati, Marco A AU - Zenati MA AD - Medical Robotics and Computer-Assisted Surgery Laboratory, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts. LA - eng PT - Journal Article DEP - 20200827 PL - United States TA - J Surg Educ JT - Journal of surgical education JID - 101303204 SB - IM OTO - NOTNLM OT - cardiac surgery OT - cognitive workload OT - heart rate variability OT - patient safety EDAT- 2020/08/31 06:00 MHDA- 2020/08/31 06:00 CRDT- 2020/09/01 06:00 PHST- 2020/04/21 00:00 [received] PHST- 2020/07/20 00:00 [revised] PHST- 2020/08/08 00:00 [accepted] PHST- 2020/09/01 06:00 [entrez] PHST- 2020/08/31 06:00 [pubmed] PHST- 2020/08/31 06:00 [medline] AID - S1931-7204(20)30309-3 [pii] AID - 10.1016/j.jsurg.2020.08.012 [doi] PST - aheadofprint SO - J Surg Educ. 2020 Aug 27:S1931-7204(20)30309-3. doi: 10.1016/j.jsurg.2020.08.012. PMID- 32258836 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2468-3574 (Electronic) IS - 2468-3574 (Linking) VI - 21 DP - 2020 TI - Characteristics, results, and reporting of contemporary surgical trials: A systematic review and analysis. PG - 1-4 LID - 10.1016/j.isjp.2020.03.002 [doi] AB - INTRODUCTION: The complexities and risks inherent to the field of surgery and surgical interventions present unique challenges to the design and analysis of surgical randomized controlled trials (RCT). Prior studies have investigated the practical and methodologic challenges posed by surgical RCTs. To date, however, a comprehensive analysis of the contemporary literature across multiple surgical subspecialties does not exist. In this descriptive analysis, we set out to characterize surgical RCTs over the past 10 years across six major surgical specialties. METHODS AND ANALYSIS: A literature search by a medical librarian will be performed to identify all surgical randomized clinical trials published between January 2009 and December 2019 in the two journals with the highest impact factor for six surgical specialties as well as two large general medicine journals. Two reviewers will independently screen the citations retrieved from the literature search and extract data according to a previously described protocol via a pre-defined data collection form. Categorical variables will be reported as counts and percentages. Following assessment of normality, continuous variables will be reported as mean (standard deviation) or median (inter-quartile range). Based on normality of data, independent t-test or the Mann-Whitney U test will be used to compare continuous variables and chi-square and Fisher's exact tests to compare categorical variables. Comparisons across multiple sets will be performed using ANOVA or Kruskak-Wallis tests. Two-sided significance testing will be used and a p-value <0.05 will be considered significant without adjustment for multiple testing. All analyses will be performed using SPSS version 24 and R within RStudio. PROSPERO (ID number: 162797). ETHICS AND DISSEMINATION: There are no ethical concerns directly pertinent to this systematic review. The retrieved data will be made available upon request. The study will be written in English and submitted for publication in a peer-reviewed journal. CI - © 2020 The Authors. FAU - Bryce Robinson, N AU - Bryce Robinson N AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Naik, Ajita AU - Naik A AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Hameed, Irbaz AU - Hameed I AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Ruan, Yongle AU - Ruan Y AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Rahouma, Mohamed AU - Rahouma M AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Weidenmann, Viola AU - Weidenmann V AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Zenati, Marco A AU - Zenati MA AD - BHS Department of Cardiothoracic Surgery, West Roxbury, MA, USA. FAU - Bhatt, Deepak L AU - Bhatt DL AD - Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. FAU - Girardi, Leonard N AU - Girardi LN AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. FAU - Kurlansky, Paul AU - Kurlansky P AD - Department of Surgery, Columbia University Medical Center, New York, NY, USA. FAU - Raja, Shahzad G AU - Raja SG AD - Department of Cardiac Surgery, Harefield Hospital, London, UK. FAU - Moher, David AU - Moher D AD - Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada. FAU - Fremes, Stephen AU - Fremes S AD - Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. FAU - Chikwe, Joanna AU - Chikwe J AD - Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Siani Medical Center, Los Angeles, CA, USA. FAU - Gaudino, Mario AU - Gaudino M AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. LA - eng PT - Journal Article DEP - 20200319 TA - Int J Surg Protoc JT - International journal of surgery protocols JID - 101758186 PMC - PMC7125342 OTO - NOTNLM OT - Methodology OT - Outcomes OT - Randomized control trial OT - Spin OT - Surgery COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2020/04/08 06:00 MHDA- 2020/04/08 06:01 CRDT- 2020/04/08 06:00 PHST- 2020/02/05 00:00 [received] PHST- 2020/03/09 00:00 [revised] PHST- 2020/03/10 00:00 [accepted] PHST- 2020/04/08 06:00 [entrez] PHST- 2020/04/08 06:00 [pubmed] PHST- 2020/04/08 06:01 [medline] AID - S2468-3574(20)30009-7 [pii] AID - 10.1016/j.isjp.2020.03.002 [doi] PST - epublish SO - Int J Surg Protoc. 2020 Mar 19;21:1-4. doi: 10.1016/j.isjp.2020.03.002. eCollection 2020. PMID- 32241376 OWN - NLM STAT- MEDLINE DCOM- 20201221 LR - 20201221 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 75 IP - 13 DP - 2020 Apr 7 TI - Randomized Trials in Cardiac Surgery: JACC Review Topic of the Week. PG - 1593-1604 LID - S0735-1097(20)30526-X [pii] LID - 10.1016/j.jacc.2020.01.048 [doi] AB - Compared with randomized controlled trials (RCTs) in medical specialties, RCTs in cardiac surgery face specific issues. Individual and collective equipoise, rapid evolution of the surgical techniques, as well as difficulties in obtaining funding, and limited education in clinical epidemiology in the surgical community are among the most important challenges in the design phase of the trial. Use of complex interventions and learning curve effect, differences in individual operators' expertise, difficulties in blinding, and slow recruitment make the successful completion of cardiac surgery RCTs particularly challenging. In fact, over the course of the last 20 years, the number of cardiac surgery RCTs has declined significantly. In this review, a team of surgeons, trialists, and epidemiologists discusses the most important challenges faced by RCTs in cardiac surgery and provides a list of suggestions for the successful design and completion of cardiac surgery RCTs. CI - Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Gaudino, Mario AU - Gaudino M AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York. Electronic address: mfg9004@med.cornell.edu. FAU - Kappetein, A Pieter AU - Kappetein AP AD - Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. Electronic address: https://twitter.com/AKappetein. FAU - Di Franco, Antonino AU - Di Franco A AD - Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York. FAU - Bagiella, Emilia AU - Bagiella E AD - Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Bhatt, Deepak L AU - Bhatt DL AD - Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. FAU - Boening, Andreas AU - Boening A AD - Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany. FAU - Charlson, Mary E AU - Charlson ME AD - Division of Clinical Epidemiology and Evaluative Science Research, Department of Medicine, Weill Cornell Medicine, New York, New York. FAU - Flather, Marcus AU - Flather M AD - Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, United Kingdom. FAU - Gelijns, Annetine C AU - Gelijns AC AD - Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Grover, Frederick AU - Grover F AD - Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado. FAU - Head, Stuart J AU - Head SJ AD - Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. FAU - Jüni, Peter AU - Jüni P AD - Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. FAU - Lamy, Andre AU - Lamy A AD - Population Health Research Institute, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. FAU - Miller, Marissa AU - Miller M AD - Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland. FAU - Moskowitz, Alan AU - Moskowitz A AD - Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. FAU - Reents, Wilko AU - Reents W AD - Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt/Saale, Germany. FAU - Shroyer, A Laurie AU - Shroyer AL AD - Northport Veterans Affairs Medical Center, Northport, New York. FAU - Taggart, David P AU - Taggart DP AD - Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom. FAU - Tam, Derrick Y AU - Tam DY AD - Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/MarcoZenatiMD. FAU - Fremes, Stephen E AU - Fremes SE AD - Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. LA - eng GR - CIHR/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - AIM SB - IM MH - *Cardiac Surgical Procedures MH - Cost-Benefit Analysis MH - Data Interpretation, Statistical MH - Humans MH - Randomized Controlled Trials as Topic MH - Research Design OTO - NOTNLM OT - *RCT OT - *cardiac surgery OT - *randomized controlled trials EDAT- 2020/04/04 06:00 MHDA- 2020/12/22 06:00 CRDT- 2020/04/04 06:00 PHST- 2020/01/05 00:00 [received] PHST- 2020/01/29 00:00 [revised] PHST- 2020/01/30 00:00 [accepted] PHST- 2020/04/04 06:00 [entrez] PHST- 2020/04/04 06:00 [pubmed] PHST- 2020/12/22 06:00 [medline] AID - S0735-1097(20)30526-X [pii] AID - 10.1016/j.jacc.2020.01.048 [doi] PST - ppublish SO - J Am Coll Cardiol. 2020 Apr 7;75(13):1593-1604. doi: 10.1016/j.jacc.2020.01.048. PMID- 31926685 OWN - NLM STAT- Publisher LR - 20200113 IS - 1097-685X (Electronic) IS - 0022-5223 (Linking) DP - 2019 Dec 12 TI - Commentary: The conundrum of cerebral malperfusion in aortic dissection. LID - S0022-5223(19)37086-2 [pii] LID - 10.1016/j.jtcvs.2019.11.103 [doi] FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: Marco_Zenati@hms.harvard.edu. LA - eng PT - Editorial DEP - 20191212 PL - United States TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - AIM SB - IM EDAT- 2020/01/14 06:00 MHDA- 2020/01/14 06:00 CRDT- 2020/01/14 06:00 PHST- 2019/11/23 00:00 [received] PHST- 2019/11/23 00:00 [revised] PHST- 2019/11/25 00:00 [accepted] PHST- 2020/01/14 06:00 [entrez] PHST- 2020/01/14 06:00 [pubmed] PHST- 2020/01/14 06:00 [medline] AID - S0022-5223(19)37086-2 [pii] AID - 10.1016/j.jtcvs.2019.11.103 [doi] PST - aheadofprint SO - J Thorac Cardiovasc Surg. 2019 Dec 12:S0022-5223(19)37086-2. doi: 10.1016/j.jtcvs.2019.11.103. PMID- 31906701 OWN - NLM STAT- MEDLINE DCOM- 20200817 LR - 20200817 IS - 1942-0080 (Electronic) IS - 1941-9651 (Linking) VI - 13 IP - 1 DP - 2020 Jan TI - Postoperative Echocardiographic Appearance of the Mitral Valve After Nonresectional Leaflet Remodeling Repair Mimicking Thrombus. PG - e009853 LID - 10.1161/CIRCIMAGING.119.009853 [doi] FAU - Bloom, Jordan P AU - Bloom JP AD - Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.B.). FAU - Shapeton, Alexander D AU - Shapeton AD AD - Department of Anesthesia, Veterans Affairs Boston Healthcare System, Harvard Medical School, West Roxbury, MA. (A.D.S.). FAU - Rasalingam, Ravi AU - Rasalingam R AD - Division of Cardiology, Veterans Affairs Boston Healthcare System, Harvard Medical School, West Roxbury, MA. (R.R.). FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Harvard Medical School, West Roxbury, MA. (M.A.Z.). LA - eng PT - Case Reports PT - Journal Article PT - Video-Audio Media DEP - 20200107 PL - United States TA - Circ Cardiovasc Imaging JT - Circulation. Cardiovascular imaging JID - 101479935 SB - IM MH - Aged MH - Coronary Thrombosis/diagnostic imaging MH - Diagnosis, Differential MH - Echocardiography/*methods MH - Humans MH - Male MH - Mitral Valve Insufficiency/*diagnostic imaging/surgery MH - Tricuspid Valve/diagnostic imaging/surgery OTO - NOTNLM OT - *aged OT - *heart atria OT - *humans OT - *mitral valve OT - *mitral valve insufficiency EDAT- 2020/01/08 06:00 MHDA- 2020/08/18 06:00 CRDT- 2020/01/08 06:00 PHST- 2020/01/08 06:00 [entrez] PHST- 2020/01/08 06:00 [pubmed] PHST- 2020/08/18 06:00 [medline] AID - 10.1161/CIRCIMAGING.119.009853 [doi] PST - ppublish SO - Circ Cardiovasc Imaging. 2020 Jan;13(1):e009853. doi: 10.1161/CIRCIMAGING.119.009853. Epub 2020 Jan 7. PMID- 31787434 OWN - NLM STAT- In-Process LR - 20210110 IS - 1532-8422 (Electronic) IS - 1053-0770 (Print) IS - 1053-0770 (Linking) VI - 34 IP - 3 DP - 2020 Mar TI - Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights from the REGROUP Trial. PG - 726-732 LID - S1053-0770(19)31130-9 [pii] LID - 10.1053/j.jvca.2019.10.053 [doi] AB - OBJECTIVES: To assess the use of epiaortic ultrasound in contemporary cardiac surgery, as well as its impact on surgical cannulation strategy and cerebrovascular events. DESIGN: Epiaortic ultrasound data was prospectively collected in the Randomized Endovein Graft Prospective (REGROUP) trial (VA Cooperative Studies Program #588, ClinicalTrials.gov, NCT01850082), which randomized 1,150 coronary artery bypass graft patients between 2014 and 2017 to endoscopic or open-vein graft harvest. SETTING: Sixteen cardiac surgery programs within the Veterans Affairs Healthcare System with expertise at performing endoscopic vein-graft harvesting. PARTICIPANTS: Veterans Affairs patients, greater than 18 years of age, undergoing elective or urgent coronary artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest with at least one planned saphenous vein graft were eligible for enrollment. INTERVENTIONS: Epiaortic ultrasound was performed by the surgeon using a high frequency (>7 MHz) ultrasound transducer. Two-dimensional images of the ascending aorta in multiple planes were acquired before aortic cannulation and cross-clamping. MEASUREMENTS AND MAIN RESULTS: Epiaortic ultrasound was performed in 34.1% (269 of 790) of patients in REGROUP. Among these patients, simple intraluminal atheroma was observed in 21.9% (59 269), and complex intraluminal atheroma comprised 2.2% (6 of 269). The aortic cannulation or cross-clamp strategy was modified based on these findings in 7.1% of cases (19 of 269). There was no difference in stroke between patients who underwent epiaortic ultrasound and those who did not (1.9% v 1.2% p = 0.523). CONCLUSIONS: Despite current guidelines recommending routine use of epiaortic ultrasound (IIa/B) to reduce the risk of stroke in cardiac surgery, in this contemporary trial, use remains infrequent, with significant site-to-site variability. CI - Published by Elsevier Inc. FAU - Shapeton, Alexander D AU - Shapeton AD AD - Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD. Electronic address: alexander.shapeton@va.gov. FAU - Leissner, Kay B AU - Leissner KB AD - Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD. FAU - Zorca, Suzana M AU - Zorca SM AD - Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD. FAU - Amirfarzan, Houman AU - Amirfarzan H AD - Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD. FAU - Stock, Eileen M AU - Stock EM AD - Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD. FAU - Biswas, Kousick AU - Biswas K AD - Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD. FAU - Haime, Miguel AU - Haime M AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA. FAU - Srinivasa, Venkatesh AU - Srinivasa V AD - Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA. FAU - Quin, Jacquelyn A AU - Quin JA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA. LA - eng SI - ClinicalTrials.gov/NCT01850082 GR - 588/ImVA/Intramural VA/United States PT - Journal Article DEP - 20191109 TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 SB - IM PMC - PMC7243360 MID - NIHMS1587182 OTO - NOTNLM OT - ascending aorta OT - coronary artery bypass grafting OT - echocardiography, transesophageal OT - plaque, atherosclerotic OT - stroke OT - ultrasonography COIS- Disclosures The authors have no conflicts of interest. EDAT- 2019/12/04 06:00 MHDA- 2019/12/04 06:00 CRDT- 2019/12/03 06:00 PHST- 2019/07/29 00:00 [received] PHST- 2019/10/27 00:00 [revised] PHST- 2019/10/31 00:00 [accepted] PHST- 2019/12/04 06:00 [pubmed] PHST- 2019/12/04 06:00 [medline] PHST- 2019/12/03 06:00 [entrez] AID - S1053-0770(19)31130-9 [pii] AID - 10.1053/j.jvca.2019.10.053 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2020 Mar;34(3):726-732. doi: 10.1053/j.jvca.2019.10.053. Epub 2019 Nov 9. PMID- 31630837 OWN - NLM STAT- MEDLINE DCOM- 20200609 LR - 20200619 IS - 1097-685X (Electronic) IS - 0022-5223 (Print) IS - 0022-5223 (Linking) VI - 159 IP - 5 DP - 2020 May TI - Commentary: Another Dutch treat. PG - 1893-1894 LID - S0022-5223(19)31937-3 [pii] LID - 10.1016/j.jtcvs.2019.08.123 [doi] FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, Mass; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: Marco_Zenati@hms.harvard.edu. FAU - Yule, Steven J AU - Yule SJ AD - Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Mass. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Comment PT - Editorial DEP - 20190923 TA - J Thorac Cardiovasc Surg JT - The Journal of thoracic and cardiovascular surgery JID - 0376343 SB - AIM SB - IM CON - J Thorac Cardiovasc Surg. 2020 May;159(5):1882-1890.e2. PMID: 31582206 MH - *Cardiac Surgical Procedures MH - Humans MH - Postoperative Period PMC - PMC7301962 MID - NIHMS1587181 EDAT- 2019/10/22 06:00 MHDA- 2020/06/10 06:00 CRDT- 2019/10/22 06:00 PHST- 2019/08/28 00:00 [received] PHST- 2019/08/28 00:00 [revised] PHST- 2019/08/28 00:00 [accepted] PHST- 2019/10/22 06:00 [pubmed] PHST- 2020/06/10 06:00 [medline] PHST- 2019/10/22 06:00 [entrez] AID - S0022-5223(19)31937-3 [pii] AID - 10.1016/j.jtcvs.2019.08.123 [doi] PST - ppublish SO - J Thorac Cardiovasc Surg. 2020 May;159(5):1893-1894. doi: 10.1016/j.jtcvs.2019.08.123. Epub 2019 Sep 23. PMID- 31629782 OWN - NLM STAT- MEDLINE DCOM- 20200629 LR - 20200629 IS - 1532-9488 (Electronic) IS - 1043-0679 (Print) IS - 1043-0679 (Linking) VI - 32 IP - 1 DP - 2020 Spring TI - Cognitive Engineering to Improve Patient Safety and Outcomes in Cardiothoracic Surgery. PG - 1-7 LID - S1043-0679(19)30327-2 [pii] LID - 10.1053/j.semtcvs.2019.10.011 [doi] AB - Cognitive engineering is focused on how humans can cope and master the complexity of processes and technological environments. In cardiothoracic surgery, the goal is to support safe and effective human performance by preventing medical errors. Strategies derived from cognitive engineering research could be introduced in cardiothoracic surgery practice in the near future to enhance patient safety and outcomes. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Zenati, Marco A AU - Zenati MA AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Medical Robotics & Computer-Assisted Surgery MRCAS) Laboratory, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts. Electronic address: Marco_Zenati@hms.harvard.edu. FAU - Kennedy-Metz, Lauren AU - Kennedy-Metz L AD - Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Medical Robotics & Computer-Assisted Surgery MRCAS) Laboratory, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts. FAU - Dias, Roger D AU - Dias RD AD - Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Review DEP - 20191017 TA - Semin Thorac Cardiovasc Surg JT - Seminars in thoracic and cardiovascular surgery JID - 8917640 SB - IM MH - *Attitude of Health Personnel MH - Cardiac Surgical Procedures/adverse effects MH - *Clinical Competence MH - *Cognition MH - *Cognitive Science MH - *Ergonomics MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Medical Errors/prevention & control/psychology MH - Mentalization MH - Patient Care Team MH - Patient Safety MH - Postoperative Complications/prevention & control MH - Risk Assessment MH - Risk Factors MH - Surgeons/*psychology MH - *Thoracic Surgical Procedures/adverse effects MH - Treatment Outcome MH - Workload PMC - PMC7060831 MID - NIHMS1544504 OTO - NOTNLM OT - Cognitive engineering OT - Human factors OT - Medical errors OT - Mental workload OT - Neuroergonomics OT - Patient safety OT - Surgical data science EDAT- 2019/10/21 06:00 MHDA- 2020/07/01 06:00 PMCR- 2021/04/01 CRDT- 2019/10/21 06:00 PHST- 2019/08/27 00:00 [received] PHST- 2019/10/09 00:00 [accepted] PHST- 2021/04/01 00:00 [pmc-release] PHST- 2019/10/21 06:00 [pubmed] PHST- 2020/07/01 06:00 [medline] PHST- 2019/10/21 06:00 [entrez] AID - S1043-0679(19)30327-2 [pii] AID - 10.1053/j.semtcvs.2019.10.011 [doi] PST - ppublish SO - Semin Thorac Cardiovasc Surg. 2020 Spring;32(1):1-7. doi: 10.1053/j.semtcvs.2019.10.011. Epub 2019 Oct 17. PMID- 31548741 OWN - NLM STAT- MEDLINE DCOM- 20191017 LR - 20200424 IS - 0022-1058 (Print) IS - 0022-1058 (Linking) VI - 51 IP - 3 DP - 2019 Sep TI - A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery. PG - 172-174 AB - Traditionally, blood flow rates on cardiopulmonary bypass are based primarily on a formula that matches cardiac index to the patient's body surface area (BSA). However, Ranucci and associates in the Goal-Directed Perfusion Trial (GIFT) trial have shown that coupling the BSA with delivery of oxygen (DO(2)), known as goal-directed perfusion (GDP), may be a safer approach to determine appropriate blood flows. The objective of this study was to create a GDP reference tool that would allow perfusionists to quickly determine the lowest acceptable blood flow needed to provide a patient of any BSA with a satisfactory DO(2) without the need for additional dedicated technology. We approached this problem by deriving a formula for flow (L/min), based on BSA, oxygen content of the blood, and a minimum DO(2) of 280 mL·min(-1)m(-2). A quick reference GDP chart was created based on the derived formula, requiring only the patient's BSA and hemoglobin level to determine a safe minimum flow rate. The proposed tool allows any cardiac surgery center to adopt the GDP technique, even in the absence of instantaneous DO(2) monitoring equipment. FAU - Srey, Rithy AU - Srey R AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. FAU - Rance, Geoffrey AU - Rance G AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. FAU - Shapeton, Alexander D AU - Shapeton AD AD - Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; and. FAU - Leissner, Kay B AU - Leissner KB AD - Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; and. FAU - Zenati, Marco A AU - Zenati MA AD - Veterans Affairs Boston Healthcare System, Division of Cardiac Surgery, Boston, Massachusetts. AD - Harvard Medical School, Cambridge, 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 RN - S88TT14065 (Oxygen) SB - T MH - *Cardiac Surgical Procedures MH - Cardiopulmonary Bypass MH - Goals MH - Humans MH - Oxygen MH - Oxygen Consumption MH - Perfusion PMC - PMC6749167 OTO - NOTNLM OT - acute renal injury OT - cardiopulmonary bypass OT - oxygen delivery OT - perfusion EDAT- 2019/09/25 06:00 MHDA- 2019/10/18 06:00 CRDT- 2019/09/25 06:00 PHST- 2019/05/31 00:00 [received] PHST- 2019/08/02 00:00 [accepted] PHST- 2019/09/25 06:00 [entrez] PHST- 2019/09/25 06:00 [pubmed] PHST- 2019/10/18 06:00 [medline] AID - 1900020 [pii] PST - ppublish SO - J Extra Corpor Technol. 2019 Sep;51(3):172-174. PMID- 31348036 OWN - NLM STAT- Publisher LR - 20210124 IS - 1528-1140 (Electronic) IS - 0003-4932 (Print) IS - 0003-4932 (Linking) DP - 2019 Jul 24 TI - Dissecting Cardiac Surgery: A Video-Based Recall Protocol to Elucidate Team Cognitive Processes in the Operating Room. LID - 10.1097/SLA.0000000000003489 [doi] AB - MINI: In this study we identified a total of 137 unique cognitive processes related to the intraoperative phase of coronary artery bypass grafting procedures. This study advances the current body of knowledge by elucidating cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple operating room team members. OBJECTIVE: The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. SUMMARY BACKGROUND DATA: Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). METHODS: A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. RESULTS: A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. CONCLUSIONS: This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR. FAU - Dias, Roger D AU - Dias RD AD - STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA. AD - Department of Emergency Medicine, Harvard Medical School, Boston, MA. FAU - Zenati, Marco A AU - Zenati MA AD - Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA. AD - Department of Surgery, Harvard Medical School, Boston, MA. FAU - Conboy, Heather M AU - Conboy HM AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA. FAU - Clarke, Lori A AU - Clarke LA AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA. FAU - Osterweil, Leon J AU - Osterweil LJ AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA. FAU - Avrunin, George S AU - Avrunin GS AD - College of Information and Computer Sciences, University of Massachusetts, Amherst, MA. FAU - Yule, Steven J AU - Yule SJ AD - STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA. AD - Department of Surgery, Harvard Medical School, Boston, MA. AD - Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. LA - eng GR - R01 HL126896/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20190724 TA - Ann Surg JT - Annals of surgery JID - 0372354 SB - AIM SB - IM PMC - PMC7241253 MID - NIHMS1587201 COIS- The authors report no conflict of interests. EDAT- 2019/07/28 06:00 MHDA- 2019/07/28 06:00 CRDT- 2019/07/27 06:00 PHST- 2019/07/27 06:00 [entrez] PHST- 2019/07/28 06:00 [pubmed] PHST- 2019/07/28 06:00 [medline] AID - 10.1097/SLA.0000000000003489 [doi] PST - aheadofprint SO - Ann Surg. 2019 Jul 24:10.1097/SLA.0000000000003489. doi: 10.1097/SLA.0000000000003489.