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University of Alabama at Birmingham Medicine leadership and physicians worked toward performance improvement in surgery by careful data analysis and collaboration. Traditionally, the role of finance has primarily revolved around [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2008.11.016 Byline: Robert J. Cerfolio (a), Ayesha S. Bryant (a), Amar A. Talati (b), Robert M. Cerfolio (b), Thomas S. Winokur (b) Abbreviations: CI, confidence interval; EUS-FNA, endoscopic ultrasound with fine needle aspiration; FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; maxSUV, maximum standardized uptake value; NSCLC, non-small cell lung cancer Abstract: The objective was to identify whether repeat positron emission tomography scan after neoadjuvant chemoradiotherapy in patients with esophageal cancer predicted a complete response. Author Affiliation: (a) Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama (b) Department of Anatomic Pathology, University of Alabama at Birmingham, Birmingham, Alabama Article History: Received 23 June 2008; Revised 3 October 2008; Accepted 11 November 2008 Article Note: (footnote) This is a nonfunded study., Presented at the Western Thoracic Surgical Association meeting, June 25-28, 2008, Kona, Hawaii.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2010.07.051 Byline: Robert James Cerfolio (a), Douglas J. Minnich (b), Ayesha S. Bryant (b) Abbreviations: IRB, institutional review board Abstract: The objective of this study was to assess the safety of general thoracic surgery in patients taking antiplatelet (clopidogrel) therapy. Author Affiliation: (a) Division of Cardiothoracic Surgery, Section of Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala (b) Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala Article History: Received 3 May 2010; Revised 12 July 2010; Accepted 19 July 2010 Article Note: (footnote) Disclosures: Robert J. Cerfolio: E plus health care, speaker; Ethicon, speaker/consultant; Neomend, consultant; Millicore, speaker/consultant; Medela, speaker/consultant; Closure/J&J, consultant; OSI Pharm, speaker; Atrium, consultant/speaker; Oncotech, speaker; Covidien, speaker; Precision, consultant/speaker. Douglas J. Minnich and Ayesha S. Bryant have no financial disclosures to report.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2008.12.014 Byline: Ayesha S. Bryant (a), Robert James Cerfolio (b) Abbreviations: BMI, body mass index; ICU, intensive care unit Abstract: We evaluated our results from our prospective database to identify possible modifications that may improve our fast-tracking protocols in selected high-risk patients. Author Affiliation: (a) Department of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala. Assistant Professor, Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham (b) Department of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala. Professor of Surgery, Chief of Section of Thoracic Surgery at University of Alabama at Birmingham Division of Cardio-Thoracic Surgery, Department of Surgery Article History: Received 6 May 2008; Revised 28 October 2008; Accepted 21 December 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2008.08.049 Byline: Robert James Cerfolio (a), Ayesha S. Bryant (b), Cheri L. Canon (c), Roopa Dhawan (d), Mohamad A. Eloubeidi (e) Abstract: The optimal management of the pylorus during esophagogastrectomy is unknown. Pyloromyotomy and pyloroplasty cause early edema and risk long-term bile reflux; however, the lack of pyloric drainage might risk early aspiration. Author Affiliation: (a) Section of Thoracic Surgery, Division of Cardio-Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala (b) Division of Cardio-thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala (c) Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (d) University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, Ala (e) Division of Gastroenterology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala Article History: Received 23 June 2008; Revised 7 August 2008; Accepted 30 August 2008 Article Note: (footnote) Read at the Thirty-fourth Annual Meeting of the Western Thoracic Surgical Association, Kona, Hawaii, June 25-28, 2008.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.09.084 Byline: Robert J. Cerfolio (a), Ayesha S. Bryant (a)(b), Lee Maniscalco (a) Abbreviations: CT, computed tomography; Nd:YAG, neodymium-doped yttrium aluminum garnet Abstract: Patients with calcified mediastinal lymph nodes who have hemoptysis or lithoptysis represent a challenging therapeutic dilemma. Author Affiliation: (a) Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham (UAB), Birmingham, Ala (b) Department of Epidemiology, University of Alabama at Birmingham (UAB), Birmingham, Ala Article History: Received 28 June 2007; Revised 30 August 2007; Accepted 14 September 2007 Article Note: (footnote) Read at the Thirty-third Annual Meeting of the Western Thoracic Surgical Association, Santa Ana Pueblo, NM, June 27-30, 2007.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.08.062 Byline: Robert James Cerfolio, Ayesha S. Bryant Abbreviations: CT, computed tomography; FDG-PET/CT, 2-deoxy-2-18F-fluoro-d-glucose positron emission tomography computed tomography; maxSUV, maximum standardized uptake value; NSCLC, non-small cell lung cancer; PET, Positron emission tomography; UAB, University of Alabama at Birmingham; VATS, video assisted thoracoscopic surgery Abstract: Video-assisted lobectomy is an increasingly used technique to treat patients with non-small cell lung cancer but it does not usually afford lung palpation. Author Affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala Article History: Received 3 May 2007; Revised 6 August 2007; Accepted 16 August 2007 Article Note: (footnote) Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-9, 2007.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.08.066 Byline: Robert James Cerfolio (a), Ayesha S. Bryant (b) Abbreviations: POD, postoperative day Abstract: Many patients have their hospital discharge delayed because their chest tube drainage is too high, despite the fact that there are no data to support the commonly used 250 mL/day threshold. Author Affiliation: (a) Section of Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala (b) Division of Cardiothoracic Surgery, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Ala Article History: Received 25 June 2007; Revised 7 August 2007; Accepted 17 August 2007 Article Note: (footnote) Presented at the Thirty-third Annual Meeting of the Western Thoracic Surgical Association, Santa Ana Pueblo, NM, June 27-30, 2007.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2006.07.032 Byline: Ayesha S. Bryant (a), Robert James Cerfolio (b) Abbreviations: CT, computed tomography; FDG, fluorodeoxyglucose; FDG-PET/CT, fluorodeoxyglucose-positron emission tomographic/computed tomographic; MaxSUV, maximum standardized uptake value; NSCLC, non-small cell lung cancer; PET, positron emission tomography; ROI, region of interest Abstract: The treatment of non-small cell lung cancer depends on the stage, and this is clinically best determined by using fluorodeoxyglucose-positron emission tomography/computed tomography. We evaluated the effect smoking has on the accuracy of this test. Author Affiliation: (a) Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Ala. (b) Division of Cardio-Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham (UAB), Birmingham, Ala. Article History: Received 8 May 2006; Revised 28 June 2006; Accepted 12 July 2006

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2005.08.070 Byline: Robert James Cerfolio (a), Ayesha S. Bryant (b), Buddhiwardhan Ojha (c) Abbreviations: EUS-FNA, endoscopic ultrasonography with fine-needle aspirate; FDG, fluorodeoxyglucose; MRI, magnetic resonance imaging; maxSUV, maximum standardized uptake value; NSCLC, non-small cell lung cancer; PET/CT, positron emission tomography/computed tomography; ROC, receiver operator characteristic Abstract: The accuracy of restaging in patients with stage IIIa non-small cell lung cancer after neoadjuvant chemoradiotherapy is unknown. Author Affiliation: (a) Division of Thoracic Surgery, University of Alabama at Birmingham, and the Division of Cardio-Thoracic Surgery, Department of Surgery, Birmingham Veterans Administration Hospital, Birmingham, Ala (b) Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Ala (c) Division of Nuclear Radiology, University of Alabama, Birmingham, Ala Article History: Received 30 May 2005; Revised 24 August 2005; Accepted 30 August 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2005.05.052 Byline: Robert James Cerfolio (a), Ayesha S. Bryant (b), Bhavik Patel (c), Alfred A. Bartolucci (d) Abstract: Thoracotomy is associated with significant pain and morbidity. Author Affiliation: (a) Section of Thoracic Surgery, University of Alabama at Birmingham, and the Division of Cardiothoracic Surgery, Department of Surgery, Birmingham Veterans Administration Hospital, Birmingham, Ala (b) Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Ala (d) Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Ala (c) University of Alabama School of Medicine, Birmingham, Ala Article History: Received 21 January 2005; Revised 20 May 2005; Accepted 24 May 2005

Background: Placing chest tubes to water seal is superior for patients with an air leak, but when a patient has a pneumothorax and an air leak the best chest tube [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2004.11.007 Byline: Robert James Cerfolio (a), Ayesha S. Bryant (b), Buddhiwardhan Ohja (c), Alfred A. Bartolucci (d) Abstract: We sought to assess whether the standard uptake value of a pulmonary nodule is an independent predictor of biologic aggressiveness. Author Affiliation: (a) Section of Thoracic Surgery, University of Alabama at Birmingham, and the Division of Cardio-Thoracic Surgery, Department of Surgery, Birmingham Veterans Administration Hospital, Birmingham, Ala (b) Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Ala (d) Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Ala (c) Department of Nuclear Medicine, University of Alabama at Birmingham, Birmingham, Ala. Article History: Received 15 July 2004; Revised 1 November 2004; Accepted 9 November 2004

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2004.12.042 Byline: Robert James Cerfolio (a)(b), Ayesha S. Bryant (c), Buddhiwardhan Ohja (d), Alfred A. Bartolucci (e), Mohamad A. Eloubeidi (f) Abstract: Patients with esophageal cancer who receive neoadjuvant chemoradiotherapy are restaged with computed tomography (CT), endoscopic ultrasound with fine needle aspiration (EUS-FNA), and integrated positron emission computed tomography (FDG-PET/CT), and the results affect treatment. Author Affiliation: (a) Section of Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala (d) Division of Nuclear Radiology, University of Alabama at Birmingham, Birmingham, Ala (f) Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Ala (b) Division of Cardio-Thoracic Surgery, Department of Surgery, the Birmingham Veterans Administration Hospital, Birmingham, Ala (c) Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Ala (e) Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Ala Article History: Received 26 June 2004; Revised 8 November 2004; Accepted 22 December 2004

Objectives: We streamlined our care using an algorithm for the postoperative care of patients who undergo Ivor Lewis esophagogastrectomy to try, to reduce hospital stay to 7 days and maintain [...]

Background: Most general thoracic surgeons use double-lumen endotracheal tube (DLET) anesthesia for all video-assisted thoracoscopic surgery, (VATS). We evaluated a single-lumen endotracheal tube (SLET) for VATS for drainage of pleural [...]

Byline: Robert J. Cerfolio, Mark S. Allen, Claude Deschamps, Victor F. Trastek, Peter C. Pairolero Abstract: Between July 1987 and May 1995, 11,315 patients underwent general thoracic surgical procedures at our institution. In 47 of these patients (0.42%), postoperative chylothorax developed. There were 32 men and 15 women with a median age of 65 years (range 21 to 88 years). Initial operation was for esophageal disease in 27 patients, pulmonary disease in 13, mediastinal mass in six, and thoracic aortic aneurysm in one. All patients were initially treated with hyperalimentation, cessation of oral intake, medium chain triglyceride diet, or a combination. Nonoperative therapy was successful in 13 cases (27.7%), and oral intake was resumed a median of 7 days later (range 2 to 15 days). Reoperation was required in the remaining 34 cases. The reoperation rate varied according to the type of initial operation. Twenty-four of the 27 patients (88.9%) who had undergone an esophageal operation required reoperation, versus only five of 13 patients (38.5%) who had undergone pulmonary resection (p < 0.001). Lymphangiography was performed in 16 patients and identified the site of the leak in 13. The thoracic duct was ligated in 32 of the 34 patients who required reoperation (94%). The remaining two patients were treated with mechanical pleurodesis and fibrin glue. Reoperation was successful in 31 of the 34 patients (91.2%). The single death among the 47 patients (2.1%) occurred in the reoperated group. Complications occurred in 18 patients (38.3%). Factors that predicted the need for reoperation were initial esophageal operation and average daily postoperative drainage greater than 1000 ml/day for 7 days. We conclude that postoperative chylothorax is an infrequent complication. Some cases can be managed without operation; however, we recommend early reoperation when drainage is greater than 1000 ml/day or if the chylous fistula occurs after an esophageal operation. The fistula can usually be controlled by ligation of the thoracic duct. (J THORAC CARDIOVASC SURG 1996;112:1361-6) Article History: Received 6 May 1996; Revised 18 June 1996; Revised 22 July 1996; Accepted 26 July 1996 Article Note: (footnote) [star] From the Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn., [star][star] Read at the Seventy-sixth Annual Meeting of The American Association for Thoracic Surgery, San Diego, Calif., April 28-May 1, 1996., a Address for reprints: Mark S. Allen, MD, Department of Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905., aa 0022-5223/96 $5.00 + 0, acents 12/6/76918

Byline: Robert J. Cerfolio, Thomas A. Orszulak, James R. Pluth, William S. Harmsen, Hartzell V. Schaff Abstract: To better understand late outcomes of mitral valve repair, we reviewed the cases of 49 consecutive patients who underwent reoperation between January 1974 and May 1992 for recurrent valve dysfunction after previous valvuloplasty for mitral regurgitation. There were 27 men (55%) and 22 women, with a median age of 63 years (range 20 to 84 years). Original procedures included annuloplasty and posterior leaflet repair in 15 patients (31%), annuloplasty and anterior leaflet repair in 15 (31%), commissural plication in 13 (27%), and complex bileaflet repairs in six (12%). Median time between initial mitral repair and reoperation was 2.4 years (range 2 months to 25.3 years). Indications for reoperation included recurrent severe mitral regurgitation in 34 patients (70%), hemolytic anemia from mitral regurgitation in seven (14%), mixed mitral regurgitation and stenosis in seven (14%), and isolated mitral stenosis in one (2%). Before reoperation, 36 patients were in New York Heart Association functional class III and 11 were in class IV. Initial repairs were intact at the second operation in 32 patients (65%), and the etiology of recurrent mitral regurgitation in these patients was fibrosis or calcification of the anulus or leaflets in 22 patients, newly ruptured chordae in seven, and perforated leaflets in three. The causes of mitral regurgitation in the 17 patients whose initial repair had failed included dehiscence of commissural repairs in nine patients, dehiscence of ring annuloplasty in four, and breakdown of chordal or leaflet repair in four. Patients with original repairs involving the anterior leaflet had a significantly shorter time between operations (p = 0.006). In eight patients (16%), the mitral valve was repaired again; in the remaining 41 patients (84%), prosthetic replacement was performed. Operative mortality rate was 4% (two patients). All eight patients who underwent mitral valve rerepair had no mitral regurgitation, trivial regurgitation, or mild regurgitation at discharge from the hospital. Follow-up was 100% complete at a mean of 5.1 years (range 1 to 19 years). Forty-one patients (87%) were in New York Heart Association functional class I or II, and survival at 5 years was 75.3%. Of the eight patients who underwent a second repair, seven had no regurgitation, trivial regurgitation, or mild regurgitation at a median of 4 years' follow-up. The low mortality associated with reoperation supports an aggressive approach toward mitral regurgitation with initial repair. A second repair can be performed in selected patients with durable results at 4 years. (J THORAC CARDIOVASC SURG 1996;111:1177-84) Article History: Received 21 June 1995; Revised 5 October 1995; Revised 29 December 1995; Accepted 5 January 1996 Article Note: (footnote) [star] From the Division of Thoracic and Cardiovascular Surgery and Section of Biostatistics, Mayo Clinic/Mayo Foundation, Rochester, Minn., [star][star] Read at the Twenty-first Annual Meeting of The Western Thoracic Surgical Association, Coeur d'Alene, Idaho, June 21-24, 1995., a Address for reprints: Thomas A. Orszulak, MD, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905., aa 0022-5223/96 $5.00 + 0, acents 12/6/71627

Dr. Mieno and colleagues have presented a well-written and interesting article (see page 1960) concerning other potential benefits derived from lung volume reduction surgery (LVRS) besides improvement in dyspnea and [...]