108 results on '"Derek R. Brinster"'
Search Results
52. Mechanical prosthetic valve malfunction diagnosed by gated non-contrast computed tomography
- Author
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Jennifer M Conroy, Zain Kassam, Derek R. Brinster, Itzhak Kronzon, and Michael Poon
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Male ,Reoperation ,medicine.medical_specialty ,media_common.quotation_subject ,Computed tomography ,Text mining ,Imaging, Three-Dimensional ,medicine ,Contrast (vision) ,Humans ,Radiology, Nuclear Medicine and imaging ,media_common ,Prosthetic valve ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,medicine.diagnostic_test ,business.industry ,Mitral Valve Insufficiency ,General Medicine ,Middle Aged ,Prosthesis Failure ,Dyspnea ,Treatment Outcome ,Disease Progression ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Follow-Up Studies - Published
- 2018
53. Short- and intermediate-term outcomes of hybrid coronary revascularization for double-vessel disease
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Nirav C. Patel, Derek R. Brinster, Karthik Seetharam, Luigi Pirelli, Jonathan M. Hemli, Varinder P. Singh, Michael C. Kim, and S. Jacob Scheinerman
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Pulmonary and Respiratory Medicine ,Male ,Hybrid coronary revascularization ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Anterior Descending Coronary Artery ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Robotic Surgical Procedures ,Risk Factors ,medicine.artery ,Internal medicine ,Medicine ,Humans ,Blood Transfusion ,Circumflex ,Coronary Artery Bypass ,Aged ,Retrospective Studies ,business.industry ,Hazard ratio ,Stent ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Length of Stay ,Middle Aged ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Right coronary artery ,Cardiology ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
We sought to evaluate midterm survival data and resource use for patients who received hybrid coronary revascularization for 2-vessel coronary disease (robotic-assisted left internal thoracic artery graft to left anterior descending coronary artery (minimally invasive direct coronary artery bypass), coupled with a stent to the circumflex or right coronary artery), compared with a concurrent cohort who had traditional coronary artery bypass grafting.A comprehensive retrospective review was undertaken of our prospectively collected database from January 2009 to December 2016. We propensity matched 207 patients who underwent hybrid coronary revascularization for double-vessel disease with patients who underwent coronary artery bypass grafting. Eight-year survival data were obtained from the National Death Index.Thirty-day mortality was 1 patient (0.5%) in each of the hybrid coronary revascularization and coronary artery bypass grafting groups. Eight-year survival for the hybrid coronary revascularization group was 187 of 207 patients (90.3%) compared with 182 of 207 patients (87.9%) for the coronary artery bypass grafting cohort. End-stage renal disease independently predicted late mortality in all patients (overall hazard ratio, 5.60, P .001; hybrid coronary revascularization hazard ratio, 5.58, P = .002; coronary artery bypass grafting hazard ratio, 4.59, P = .006). Female patients who underwent hybrid coronary revascularization had a higher incidence of late death (hazard ratio, 2.47, P = .05). Length of stay and perioperative transfusion requirements were lower in the hybrid coronary revascularization group (P .0001).Hybrid coronary revascularization for double-vessel coronary disease is associated with similar short-term outcomes and intermediate-term survival as traditional coronary artery bypass grafting. Hybrid coronary revascularization is associated with lower transfusion requirements and a shorter length of stay than coronary artery bypass grafting.
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- 2018
54. ROLE OF STENT GRAFTS IN PATIENTS WITH MARFAN SYNDROME PRESENTING WITH ACUTE TYPE B AORTIC DISSECTION: A COMPARISON STUDY
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Himanshu J. Patel, Daniel G. Montgomery, Marc L. Schermerhorn, Derek R. Brinster, Joseph S. Coselli, Clayton A. Kaiser, Eduardo Bossone, Christoph A. Nienaber, M. Mujeeb Zubair, Santi Trimarchi, Maral Ouzounian, Jean Bismuth, Marek P. Ehrlich, Valerio Tolva, Kim A. Eagle, Eric M. Isselbacher, Zubair, Mm, Trimarchi, S, Patel, H, Ehrlich, M, Brinster, D, Ouzounian, M, Kaiser, C, Tolva, V, Schermerhorn, M, Coselli, J, Bossone, E, Eagle, K, Montgomery, D, Isselbacher, E, Nienaber, C, and Bismuth, J
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musculoskeletal diseases ,Aortic dissection ,Marfan syndrome ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stent ,Aortic repair ,medicine.disease ,Surgery ,Acute type ,cardiovascular system ,medicine ,Comparison study ,In patient ,cardiovascular diseases ,skin and connective tissue diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study aimed to assess the safety of thoracic endovascular aortic repair (TEVAR) for type B acute aortic dissection (TBAD) in Marfan Syndrome (MFS). Patients enrolled in the International Registry of Acute Aortic Dissection were stratified by those with (N=18) and without MFS (N=550) who had
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- 2018
55. Type A Dissection Involving Intimo-Intimal Intussusception Through the Aortic Valve
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Sarah Armour, Trygve K. Armour, Derek R. Brinster, and Pingle Reddy
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Adult ,Aortic valve ,medicine.medical_specialty ,Computed tomography ,Dissection (medical) ,Marfan Syndrome ,Aortic aneurysm ,Aneurysm ,Intussusception (medical disorder) ,medicine ,Humans ,Type a dissection ,Aortic Aneurysm, Thoracic ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Aortic Dissection ,medicine.anatomical_structure ,Aortic Valve ,Female ,Radiology ,Presentation (obstetrics) ,Tomography, X-Ray Computed ,business ,Echocardiography, Transesophageal - Abstract
The presentation, evaluation, management, and outcome of a case of type A circumferential dissection involving repeated retrograde intussusception of the intimal flap through the aortic valve is described in this case report. Fewer than 20 intimo-intimal intussusception cases have been described since the first report was published by Hufnagel in 1962, and outcomes have typically been poor because of delays in diagnosis. This case shows the potential for a positive outcome when the diagnosis of intimo-intimal intussusception is entertained and confirmed early in the course of treatment. Preoperative computed tomography and intraoperative transesophageal echocardiography were essential in diagnosis and operative planning.
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- 2015
56. Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes
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Kush Dholakia, Dror Perk, Jonathan M. Hemli, Nirav C. Patel, S. Jacob Scheinerman, Edward R R DeLaney, and Derek R. Brinster
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Male ,medicine.medical_specialty ,New York ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Bicuspid aortic valve ,Postoperative Complications ,medicine.artery ,Ascending aorta ,medicine ,Thoracic aorta ,Humans ,Elective surgery ,Retrospective Studies ,Acute aortic syndrome ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Survival Rate ,030228 respiratory system ,Elective Surgical Procedures ,Anesthesia ,cardiovascular system ,Female ,Morbidity ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Follow-Up Studies - Abstract
Background: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution. Methods: The majority of our patients were male, mean age 61.19 ± 13.33 years. Two patients had Marfan syndrome. Twenty-eight patients had bicuspid aortic valve. Thirty-four patients underwent aortic root replacement utilizing a composite valve/graft conduit; 23 had valve-sparing root replacements. The ascending aorta was replaced in 89 patients; 80 (89.9%) of these included a period of circulatory arrest at moderate hypothermia utilizing unilateral selective antegrade cerebral perfusion. Results: Thirty-day mortality was zero. Perioperative stroke occurred in 2 patients, both of whom completely recovered prior to discharge. No patients required re-exploration for bleeding. One patient developed a sternal wound infection. Fifteen patients required readmission to hospital within thirty days of discharge. Conclusion: Elective surgery for aneurysm of the proximal aorta is safe, reproducible, and is associated with outcomes that are superior to those seen in an acute aortic syndrome. It may be appropriate to offer surgery to younger patients with proximal aortic aneurysms at smaller diameters, even if their aortic dimensions do not yet meet traditional guidelines for surgical intervention.
- Published
- 2017
57. Central Aortic Cannulation for Stanford Type A Aortic Dissection with the Use of Three-Dimensional and Two-Dimensional Transesophageal Echocardiography
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Vigneshwar Kasirajan, Kenneth Sadler Meyers, Derek R. Brinster, Dan Parrish, and Pingle Reddy
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Pulmonary and Respiratory Medicine ,Aortic dissection ,Aortic arch ,medicine.medical_specialty ,Aorta ,business.industry ,Retrospective cohort study ,medicine.disease ,Arterial cannulation ,law.invention ,Surgery ,Aneurysm ,Randomized controlled trial ,law ,medicine.artery ,medicine ,Cardiopulmonary bypass ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure. Methods This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross-clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation. Results The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30-day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48 hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation. Conclusions This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques. doi: 10.1111/jocs.12411 (J Card Surg 2014;29:729–732)
- Published
- 2014
58. Undersized Stent Grafts for Acute Mesenteric Ischemia in Chronic Type B Dissection
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Andrew H. Maloney, Derek R. Brinster, and Eden C. Payabyab
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Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,medicine.medical_treatment ,False lumen ,Lumen (anatomy) ,030204 cardiovascular system & hematology ,Acute ischemia ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Acute mesenteric ischemia ,Complete occlusion ,medicine ,Humans ,030212 general & internal medicine ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Stent ,Type b dissection ,Surgery ,Blood Vessel Prosthesis ,Dissection ,Aortic Dissection ,Mesenteric Ischemia ,Chronic Disease ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Acute ischemia in chronic type B dissections carries high rates of morbidity and mortality. A 29-year-old woman with a chronic type B dissection presented with acute abdominal pain. Imaging revealed a worsening dissection with pseudocoarctation causing near complete occlusion of the true lumen by the false lumen. We placed purposefully undersized stent grafts to treat acute mesenteric ischemia by improving true lumen flow. The patient was discharged on postoperative day 4 without adverse events. We suggest that endovascular rescue by placing undersized stent grafts can provide improved flow to the mesenteric vessels with continued false lumen flow to vital organs.
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- 2016
59. Long-term Surveillance and Management of a Degenerating Thoracoabdominal Aneurysm
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Samuel Lee, Allan M. Conway, Alfio Carroccio, and Derek R. Brinster
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medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Thoracoabdominal aneurysm ,Term (time) - Published
- 2019
60. ABSOLUTE AORTIC SIZE BUT NOT INDEXED AORTIC SIZE PREDICTS LATE OUTCOMES FOR FEMALES UNDERGOING MEDICAL MANAGEMENT OF TYPE B DISSECTION
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Davide Pacini, Derek R. Brinster, Christina L. Fanola, Stuart Hutchison, Thomas G. Gleason, Eric M. Isselbacher, Christoph A. Nienaber, Neal M. Foley, Marek Ehrlich, Mark E. Peterson, Raffi Bekeredjian, Firas F. Mussa, Kim A. Eagle, Daniel G. Montgomery, Alan C. Braverman, Kevin M. Harris, and Melissa M. Levack
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Aortic dissection ,medicine.medical_specialty ,business.industry ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Type b dissection ,Adverse effect ,medicine.disease ,Aortic disease - Abstract
Indexed aortic diameters have shown improved stratification for prediction of adverse events among men and women with aortic disease; less is known about the prognostic value of these indices post-dissection. We evaluated whether indexed aortic diameters at time of Type B acute aortic dissection (
- Published
- 2019
61. [Untitled]
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Efstathia Mihelis, S. Jacob Scheinerman, Kush Dholakia, Chad Kliger, Derek R. Brinster, Byron Patton, Richard S. Lazzaro, Luigi Pirelli, Jonathan M. Hemli, Nirav Patel, and Harry Gill
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Critical Care and Intensive Care Medicine ,business ,High flow ,Cardiac surgery - Published
- 2019
62. Endovascular Abdominal Aortic Stent Grafting in Unrecognized Salmonella Aortitis
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K. Kommaraju and Derek R. Brinster
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Male ,Reoperation ,medicine.medical_specialty ,Salmonella ,Prosthesis-Related Infections ,Aortography ,Aortic stent ,medicine.disease_cause ,Blood Vessel Prosthesis Implantation ,Predictive Value of Tests ,Blood vessel prosthesis ,Penetrating atherosclerotic ulcer ,medicine ,Humans ,Aorta, Abdominal ,cardiovascular diseases ,Diagnostic Errors ,Prosthesis-Related Infection ,Device Removal ,Aortitis ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,General Medicine ,Middle Aged ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,surgical procedures, operative ,Salmonella Infections ,Stents ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Abdominal endovascular graft infection is a rare but life-threatening complication of endovascular repair that can be challenging to manage. This report delineates the progression of a unique set of events leading to Salmonella graft infection and investigates current treatment options.
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- 2012
63. Endovascular Abdominal Aortic Aneurysm Repair Through a Persistent Sciatic Artery
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Michelle L. DesChamplain, Derek R. Brinster, and Rajesh Ramanathan
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Computed tomography ,Femoral artery ,Iliac Artery ,Aortic aneurysm ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Endovascular treatment ,Aortic aneurysm repair ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,General Medicine ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Femoral Artery ,cardiovascular system ,Blood supply ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Sciatic artery ,Aortic Aneurysm, Abdominal - Abstract
Conventional access for endovascular infrarenal aortic aneurysm repair is through the femoral artery. In rare circumstances, an anomalous persistent sciatic artery may replace the femoral arterial system as the main blood supply of the lower extremity. We report the case of a 64-year-old woman with a rapidly expanding infrarenal abdominal aortic aneurysm. Preoperative computed tomography revealed a right persistent sciatic artery with an ipsilateral atrophic femoral artery. Her aortic aneurysm was successfully repaired using an endovascular approach with access through the right persistent sciatic artery and contralateral femoral artery. A persistent sciatic artery can be used as an access for endovascular treatment of an infrarenal aortic aneurysm. This technique can be extrapolated to the treatment of distal or contralateral aneurysms, precluding the need for open operation.
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- 2015
64. TCT-734 Heart Failure Functional Classification Following Transcatheter versus Surgical Aortic Valve Replacement: a Meta-Analysis of Three Randomized Controlled Trials
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S. Jacob Scheinerman, Rhanderson Cardoso, Nicolo Piazza, Giuseppe Martucci, Rodrigo Mendirichaga, Mohammad Ansari, Nirav C. Patel, Derek R. Brinster, and Daniel Garcia
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medicine.medical_specialty ,business.industry ,medicine.disease ,Surgery ,law.invention ,Aortic valve replacement ,Randomized controlled trial ,law ,Internal medicine ,Heart failure ,Meta-analysis ,Cardiology ,medicine ,cardiovascular system ,business ,Cardiology and Cardiovascular Medicine - Published
- 2015
- Full Text
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65. TCT-108 Long-term Survival After Hybrid Coronary Revascularization for Triple-Vessel Disease: How Does it Compare to Coronary Artery Bypass Surgery or Multi-Vessel Percutaneous Intervention?
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Luigi Pirelli, Jacob Scheinerman, Craig Basman, Derek R. Brinster, Jonathan M. Hemli, Michael C. Kim, Nirav C. Patel, Varinder P. Singh, and Karthik Seetharam
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Hybrid coronary revascularization ,medicine.medical_specialty ,Percutaneous ,Left internal mammary artery ,business.industry ,medicine.medical_treatment ,Coronary artery bypass surgery ,surgical procedures, operative ,Triple vessel disease ,Surgical Graft ,Internal medicine ,Long term survival ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Hybrid coronary revascularization (HCR) combines a left internal mammary artery (LIMA) to left anterior descending (LAD) surgical graft, usually performed via a robotic-assisted, minimally-invasive approach, with drug-eluting stents placed in the remaining diseased non-LAD vessels. We sought to
- Published
- 2018
66. DOES MINIMALLY-INVASIVE BYPASS SURGERY AFFORD A LONG-TERM SURVIVAL ADVANTAGE COMPARED WITH DRUG-ELUTING STENT FOR ISOLATED COMPLEX DISEASE OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY?
- Author
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Chad Kliger, Varinder P. Singh, Luigi Pirelli, Derek R. Brinster, S. Jacob Scheinerman, Jonathan M. Hemli, Cindy L. Grines, Karthik Seetharam, Efstathia Mihelis, Michael C. Kim, and Nirav C. Patel
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Complex disease ,Anterior Descending Coronary Artery ,surgical procedures, operative ,medicine.anatomical_structure ,Bypass surgery ,Drug-eluting stent ,Internal medicine ,Conventional PCI ,Long term survival ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
No significant difference in long-term survival has, as yet, been identified for patients with isolated proximal lesions of the left anterior descending (LAD) coronary artery undergoing either robotic-assisted minimally-invasive coronary artery bypass (MIDCAB) or percutaneous intervention (PCI) with
- Published
- 2018
67. STAGED ROBOTICALLY-ASSISTED MIDCAB AND TAVR FOR TREATMENT OF CONCOMITANT SEVERE AORTIC STENOSIS AND COMPLEX CORONARY ARTERY DISEASE: SINGLE-CENTER EXPERIENCE
- Author
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Nirav Patel, Luigi Pirelli, Dillon Weiss, Efstathia Mihelis, Jacob Scheinerman, Derek R. Brinster, Somsupha Kanjanauthai, Chad Kliger, and Jonathan M. Hemli
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Coronary artery disease ,medicine.medical_specialty ,Stenosis ,business.industry ,Concomitant ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,Single Center ,business - Published
- 2018
68. PREDICTORS AND OUTCOMES ASSOCIATED WITH POST-OPERATIVE PERICARDIAL TAMPONADE IN TYPE A ACUTE AORTIC DISSECTION PATIENTS
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Truls Myrmel, Arturo Evangelista, Thomas G. Gleason, Davide Pacini, Derek R. Brinster, Daniel G. Montgomery, Nilto C. De Oliveira, Joseph S. Coselli, Maral Ouzounian, Kim A. Eagle, Christoph A. Nienaber, Marc Schermerhorn, Swechya Banskota, G. Chad Hughes, Stuart Hutchison, and Eric M. Isselbacher
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Aortic dissection ,medicine.medical_specialty ,business.industry ,Dissection (medical) ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Acute type ,cardiovascular system ,medicine ,Pericardium ,Tamponade ,Post operative ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Pericardial tamponade (PT) is a dangerous complication of surgeries requiring dissection of the pericardium, including Acute Type A Aortic Dissection (TAAAD) repair. However, there are few studies on the predictors and/or outcomes associated with PT development post-surgery for TAAAD. We evaluated
- Published
- 2018
69. ASCENDING AORTIC PSEUDOANEURYSM WITH COMPRESSION OF LEFT MAIN CORONARY ARTERY
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John N. Makaryus, Loukas Boutis, Shahryar G. Saba, Michael P. Gannon, Rick A. Esposito, and Derek R. Brinster
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medicine.medical_specialty ,Routine screening ,business.industry ,Mechanical Aortic Valve ,Compression (physics) ,medicine.anatomical_structure ,medicine.artery ,Internal medicine ,Pulmonary artery ,cardiovascular system ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Aortic pseudoaneurysm ,Artery - Abstract
Compression of the left main coronary artery (LMCA) has been reported with pulmonary artery enlargement but rarely from aortic pathology. A 75-year-old man with history of mechanical aortic valve replacement (AVR) with aortic conduit for severe aortic insufficiency underwent routine screening
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- 2018
70. 112: HEMODIALYSIS (HD) ON POSTOPERATIVE DAY ZERO (POD 0) FOLLOWING CARDIAC SURGERY IMPROVES OUTCOMES
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Efstathia Mihelis, Chad Kliger, Jonathan M. Hemli, S. Jacob Scheinerman, Richard S. Lazzaro, Kush Dholakia, Luigi Pirelli, Maria V. DeVita, Derek R. Brinster, Byron Patton, and Nirav Patel
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medicine.medical_specialty ,Point of delivery ,business.industry ,Internal medicine ,medicine ,Cardiology ,Critical Care and Intensive Care Medicine ,business ,Hemodialysis hd ,Cardiac surgery - Published
- 2018
71. Endovascular Repair of Blunt Thoracic Aortic Injuries
- Author
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Derek R. Brinster
- Subjects
Pulmonary and Respiratory Medicine ,Thorax ,medicine.medical_specialty ,Aorta, Thoracic ,Prosthesis Design ,Wounds, Nonpenetrating ,Aortic stent ,Aortography ,Lesion ,Blood Vessel Prosthesis Implantation ,Blunt ,Blood vessel prosthesis ,medicine.artery ,medicine ,Humans ,Surgical repair ,Aorta ,business.industry ,General Medicine ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Cardiothoracic surgery ,cardiovascular system ,Stents ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Blunt traumatic aortic injury is a highly fatal injury caused from rapid deceleration of the thorax. Most victims do not survive to obtain emergency medical care. Immediate open surgical repair had been the standard of care for decades, but more recent strategies and the emergence of thoracic aortic endografting have changed protocols for the treatment of this highly lethal lesion. This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population.
- Published
- 2009
72. Lupus Aortitis Leading to Aneurysmal Dilatation in the Aortic Root and Ascending Aorta
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Derek R. Brinster, John D. Grizzard, and Alok Dash
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medicine.medical_specialty ,Young Adult ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Lupus Erythematosus, Systemic ,skin and connective tissue diseases ,Aorta ,Aortitis ,Autoimmune disease ,Systemic lupus erythematosus ,medicine.diagnostic_test ,business.industry ,Autoantibody ,Magnetic resonance imaging ,medicine.disease ,Aortic Aneurysm ,Treatment Outcome ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Female ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Vasculitis ,Dilatation, Pathologic ,Artery - Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs, tissues, and cells undergo damage mediated by tissue-binding autoantibodies and immune complexes. We describe the case of a 23-year-old African American woman with a history of recurrent pneumonias. Computed tomography, magnetic resonance imaging (MRI), and echocardiographic evaluations, as well as clinical and laboratory findings, indicated a diagnosis of SLE with inflammatory aortitis secondary to SLE vasculitis. A repeat MRI revealed a rapidly expanding aortic root and ascending aorta that required prompt operative repair. The ascending aorta and aortic root were replaced with a mechanical valved conduit, and a coronary artery bypass to the posterior descending artery was performed because of related erosion into the intima of the right coronary ostium. The patient has done well postoperatively. Aortitis and aortic aneurysms are an uncommon manifestation of SLE, and a literature search revealed an apparent association between aortic aneurysms and steroid medications for SLE. This case is the first report of aortitis resulting in a nondissecting aortic root aneurysm in an SLE patient without a history of steroid use, indicating that all SLE patients, including those without a history of steroid use, require screening for aortic disease to improve surgical outcomes and to prevent fatal complications.
- Published
- 2009
73. Endovascular Repair of the Descending Thoracic Aorta for Penetrating Atherosclerotic Ulcer Disease
- Author
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Derek R Brinster
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Arteriosclerosis ,medicine.medical_treatment ,Aorta, Thoracic ,Disease ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Penetrating atherosclerotic ulcer ,medicine.artery ,Humans ,Medicine ,Thoracic aorta ,cardiovascular diseases ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Stent ,medicine.disease ,Surgery ,Dissection ,surgical procedures, operative ,Cardiothoracic surgery ,cardiovascular system ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The pathological variants of acute aortic syndromes include classic dissection, intramural hematomas, and penetrating atherosclerotic ulcers (PAUs). The subject of the appropriate management and treatment of PAUs continues to expand as this disease entity is increasingly identified. The application of thoracic endografting, or thoracic endovascular aortic repair (TEVAR), to treat these acute aortic pathologies is clearly evolving and the ultimate effectiveness and durability of thoracic endografting remains to be determined as clinical experience increases. The disease pathology of PAUs and the use of endovascular stent graft placement in PAU disease are closely examined in this manuscript.
- Published
- 2009
74. Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge
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Parvez Mir, Derek R. Brinster, Gyanendra Acharya, Hejmadi Prabhu, and Ajibola Monsur Adedayo
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Embolectomy ,Case Report ,law.invention ,Embolus ,law ,medicine.artery ,medicine ,Cardiopulmonary bypass ,cardiovascular diseases ,lcsh:RC705-779 ,Pressure overload ,Tricuspid valve ,biology ,business.industry ,lcsh:Diseases of the respiratory system ,medicine.disease ,Troponin ,Pulmonary embolism ,Surgery ,medicine.anatomical_structure ,Pulmonary artery ,biology.protein ,cardiovascular system ,business - Abstract
Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell’s sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed for a persistent right lower extremity DVT. Hypercoagulable work-up was negative. Patient continued to do well after discharge on Coumadin. Open embolectomy offers great promises where there is no consensus in optimal management approach in such patients. Bedside echocardiogram is vital in risk stratification and deciding choice of advanced PE treatment.
- Published
- 2015
75. Use of del Nido Cardioplegia in Adult Cardiac Surgery
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Derek R. Brinster, Trygve K. Armour, Rajesh Ramanathan, and Dan Parrish
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Treatment outcome ,law.invention ,Body Mass Index ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cardiopulmonary Bypass ,Adult patients ,business.industry ,Retrospective cohort study ,Hypothermia ,Middle Aged ,Cardiac surgery ,Treatment Outcome ,Anesthesia ,Reperfusion Injury ,Cardiology ,Heart Arrest, Induced ,Feasibility Studies ,Surgery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background del Nido cardioplegia was developed to protect pediatric hearts, and similar to pediatric hearts, older adult hearts tolerate ischemia–reperfusion poorly. This study investigates the feasibility of del Nido cardioplegia as an alternative to conventional Buckberg cardioplegia in adult cardiac surgery. Methods A total of 142 adult patients undergoing cardiopulmonary bypass with del Nido cardioplegia and conventional Buckberg cardioplegia were retrospectively reviewed. Results Fewer doses of cardioplegia and fewer defibrillations were noted with del Nido cardioplegia, and there were no significant differences in incidence of postoperative events. Conclusion del Nido cardioplegia may be a feasible alternative to conventional Buckberg cardioplegia.
- Published
- 2015
76. Are Penetrating Aortic Ulcers Best Treated Using an Endovascular Approach?
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Derek R. Brinster, Venkatesh G. Ramaiah, Edward B. Diethrich, James Williams, Grayson H. Wheatley, and Julio A. Rodriguez‐Lopez
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Thorax ,medicine.medical_specialty ,Aortic Diseases ,Investigational device exemption ,Blood Vessel Prosthesis Implantation ,Patient age ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Ulcer ,Aged ,Aged, 80 and over ,Surgical repair ,Aorta ,business.industry ,Operative mortality ,Respiratory disease ,Middle Aged ,Atherosclerosis ,medicine.disease ,Surgery ,cardiovascular system ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Optimal treatment for penetrating aortic ulcers has yet to be determined. Although open surgical repair is an effective therapeutic option, less invasive alternatives such as endoluminal grafting are emerging as a potential adjunct for the treatment of penetrating aortic ulcers isolated to the descending thoracic aorta. We reviewed our cumulative experience with thoracic endografting for penetrating aortic ulcers of the descending thoracic aorta.Between March 2003 and September 2005, 21 patients with penetrating aortic ulcers of the descending thoracic aorta were treated with Gore TAG thoracic endoluminal stent-grafts as part of a single-center investigational device exemption protocol.Mean patient age was 73 +/- 12 years, and 7 (33%) of 21 were men and 14 (67%) were women. Patients presented with both acute (14 days; 16/21, 76.2%) and chronic symptoms (5/21, 23.8%). The endoluminal stent-graft was successfully delivered in all 21 patients. No endoleaks were detected at 30-days postprocedurally or in follow-up (mean follow-up, 14 +/- 18 months). The 30-day mortality was 0%, and overall mortality was 4.8% (1/21), which was unrelated to the endovascular intervention.Endovascular therapy for penetrating aortic ulcers of the descending thoracic aorta is safe and feasible. The number of patients diagnosed with penetrating aortic ulcers is expected to increase as improved imaging systems are becoming more commonplace. As a result, new and safer treatment paradigms will become even more important in the treatment of aortic diseases. Compared with historical surgical results, endovascular therapy for penetrating aortic ulcers of the descending thoracic aorta appears to have less operative mortality and is as equally effective as open surgical repair. Long-term surveillance and continued investigation are warranted.
- Published
- 2006
77. Midterm Results of the Edge-to-Edge Technique for Complex Mitral Valve Repair
- Author
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Derek R. Brinster, Michael N. D'Ambra, Daniel Unić, Lawrence H. Cohn, and Nadia Nathan
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Thorax ,medicine.medical_specialty ,New York Heart Association Class ,medicine.medical_treatment ,Ventricular outflow tract obstruction ,Internal medicine ,Mitral valve ,Secondary Prevention ,medicine ,Humans ,Cardiac Surgical Procedures ,Aged ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,Mitral regurgitation ,Ejection fraction ,business.industry ,Suture Techniques ,Respiratory disease ,Mitral Valve Insufficiency ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The edge-to-edge technique (E2E) has been advocated for the complex repair of myxomatous mitral valves. We compared outcomes of E2E performed in patients at risk for systolic anterior motion (SAM) versus outcomes in patients with residual mitral regurgitation (MR) after repair completion.A total of 1,612 patients had repair of myxomatous mitral valves between June 1997 and December 2003 at Brigham and Women's Hospital. The E2E was used in 72 (4.5%) patients. Fifty-two patients (52/72; group I) had E2E for persistent MR after complex repair. Twenty patients (20/72; group II) had E2E for high risk of post-repair SAM and left ventricular outflow tract obstruction. Mean age of the patients was 61 +/- 14 years; 47 were male, average New York Heart Association class at admission was 2.4 +/- 0.6, and mean left ventricular ejection fraction was 56 +/- 12%.The operative mortality was zero. Immediate postoperative MR was significantly improved in all patients compared with the preoperative grade (p value0.0005). Mean follow-up was 388 days. In those in whom E2E was used for residual MR without SAM risk (group I), postoperative MR (or = 2+) was detected in 15 of 52 patients at 6 months. In group II, SAM was completely eliminated and the mean MR grade in the immediate postoperative period was 0.5 +/- 0.7. There was no long-term recurrence of MR in group II.This study suggests that E2E eliminates SAM and long-term MR in patients with pre-repair echocardiographic predictors of SAM. The E2E is not efficacious in preventing long-term recurrent MR if performed for residual MR after complex mitral repair.
- Published
- 2006
78. Simplified Technique of Total Aortic Arch Replacement With Minimal Circulatory and Myocardial Ischemia
- Author
-
Derek R. Brinster
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mild hypothermia ,Time Factors ,Myocardial ischemia ,Myocardial Ischemia ,Aorta, Thoracic ,Risk Assessment ,Brain Ischemia ,Cohort Studies ,Internal medicine ,Aortic arch replacement ,Humans ,Medicine ,Arch ,Cerebral perfusion pressure ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cardiopulmonary Bypass ,business.industry ,Anastomosis, Surgical ,Hemodynamics ,Middle Aged ,Plastic Surgery Procedures ,Treatment Outcome ,Cerebrovascular Circulation ,Anesthesia ,Circulatory system ,Cardiology ,Female ,Surgery ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Follow-Up Studies - Abstract
This manuscript describes the initial experience of 15 patients undergoing aortic arch replacement using a modification of the trifurcate arch technique described by Spielvogel and coworkers [1]. This technique provides continuous antegrade cerebral perfusion and minimal myocardial ischemia with mild hypothermia.
- Published
- 2012
79. Novel Percutaneous Apical Exclusion of a Left Ventricular Pseudoaneurysm After Complicated Transapical Transcatheter Aortic Valve Replacement
- Author
-
Soraya Merchan, Vladimir Jelnin, Gila Perk, Chad Kliger, Chi-Hion Li, Derek R. Brinster, Carlos E. Ruiz, Itzhak Kronzon, and Francisco Javier Martinez
- Subjects
Reoperation ,Cardiac Catheterization ,medicine.medical_specialty ,Percutaneous ,Transcatheter aortic ,Bypass grafting ,Septal Occluder Device ,Heart Ventricles ,medicine.medical_treatment ,Prosthesis ,Transcatheter Aortic Valve Replacement ,Imaging, Three-Dimensional ,Postoperative Complications ,Valve replacement ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Cardiac Surgical Procedures ,Heart Aneurysm ,Aged ,business.industry ,Left ventricular pseudoaneurysm ,Aortic Valve Stenosis ,Surgery ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,Fluoroscopy ,cardiovascular system ,Cardiology ,Female ,Tomography, X-Ray Computed ,business ,Cardiology and Cardiovascular Medicine ,Aneurysm, False ,Artery - Abstract
A 78-year-old woman with a history of coronary artery bypass grafting underwent transapical transcatheter aortic valve replacement with a Sapien XT (Edwards, Irvine, California) prosthesis that was complicated by an apical left ventricular pseudoaneurysm (LVPA). Unsuccessful attempts at closure
- Published
- 2015
- Full Text
- View/download PDF
80. Advances in the treatment of acute type a dissection: an integrated approach
- Author
-
Robert C. Gorman, Thomas G. Gleason, Alberto Pochettino, Y. Joseph Woo, Joseph E. Bavaria, and Derek R. Brinster
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,Aortic valve ,medicine.medical_specialty ,Aorta, Thoracic ,Risk Assessment ,Brain Ischemia ,law.invention ,Aortic aneurysm ,Postoperative Complications ,Aneurysm ,law ,Cause of Death ,Monitoring, Intraoperative ,medicine.artery ,medicine ,Cardiopulmonary bypass ,Humans ,Hospital Mortality ,Aortic rupture ,Aged ,Heart Valve Prosthesis Implantation ,Aortic Aneurysm, Thoracic ,business.industry ,Brain ,Middle Aged ,medicine.disease ,Surgery ,Cardiac surgery ,Aortic Dissection ,medicine.anatomical_structure ,Cardiothoracic surgery ,Aortic Valve ,Anesthesia ,Female ,Tissue Adhesives ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Acute type A dissections require surgery to prevent death from proximal aortic rupture or malperfusion. Most series over the past decade have reported a death rate in the range of 15% to 30%. The objective of this study is to examine the effect of an integrated surgical approach on the treatment of acute type A dissections. Methods From January 1994 to April 2002, 163 consecutive patients underwent repair of acute type A dissection. All had an integrated operative management as follows: intraoperative transesophageal echocardiography; hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion to replace the aortic arch; HCA established after 3 minutes of electroencephalographic silence in neuromonitored patients (60%) or after 45 minutes of cooling in patients who were not neuromonitored (40%); reinforcement of the residual arch tissue with a Teflon felt "neo-media;" cannulation of the arch graft to reestablish cardiopulmonary bypass at the completion of HCA (antegrade graft perfusion); and remodeling of the sinus of Valsalva segments with Teflon felt "neo-media" and aortic valve resuspension or replacement with a biological or mechanical valved conduit. When HCA times were greater than 50 minutes, antegrade cerebral perfusion is used. Since Februay 1999, BioGlue has been used as an anastomotic adjunct in the repair of type A dissections. Results Mean age was 62 ± 14 years, with 68% men and 15% with previous cardiac surgery. Seven percent of patients presented with a preoperative neurologic deficit, and 3% developed a new cerebrovascular accident after dissection repair. The in-hospital death rate was 9.8%. Excluding the patients with preoperative strokes (7%) and those with postoperative stroke (3%), the in-hospital death rate was 6.6%. In 6 patients, prompt changes in circulatory management consisting of switching cannulation sites or cross-clamp release with direct temporary aortic arch fenestration occurred when there were sudden changes in electroencephalogram during cooling. Conclusions A standardized approach to the treatment of acute type A dissections has improved outcomes. Our 55% mortality in patients with preoperative cerebral vascular accident (CVA) suggests that this group may be candidates for medical or delayed surgical treatment. Conversely, our 6.6% mortality rate for neurologically intact patients warrants aggressive and expeditious surgical intervention.
- Published
- 2002
81. AN UNEXPECTED GUEST IN THE RIGHT VENTRICLE
- Author
-
Chad Kliger, Nirav C. Patel, Bernard Kadosh, Luigi Pirelli, S. Jacob Scheinerman, Derek R. Brinster, Alaeldin Eltom, Gila Perk, and Jeremy Jacobson
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Ventricle ,business.industry ,Internal medicine ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
82. Central aortic cannulation for Stanford type a aortic dissection with the use of three-dimensional and two-dimensional transesophageal echocardiography
- Author
-
Derek R, Brinster, Dan W, Parrish, Kenneth Sadler, Meyers, Pingle, Reddy, and Vigneshwar, Kasirajan
- Subjects
Male ,Cardiopulmonary Bypass ,Time Factors ,Echocardiography, Three-Dimensional ,Aorta, Thoracic ,Middle Aged ,Aortic Aneurysm ,Catheterization ,Aortic Dissection ,Surgery, Computer-Assisted ,Catheterization, Peripheral ,Humans ,Female ,Safety ,Echocardiography, Transesophageal ,Aged ,Retrospective Studies - Abstract
There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure.This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross-clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation.The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30-day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48 hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation.This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques.
- Published
- 2014
83. Transapical arterial cannulation for salvage cardiopulmonary bypass in transcatheter aortic valve replacement
- Author
-
Derek R. Brinster, Jay A. Patel, Zachary M. Gertz, Harry L. McCarthy, and Ty M. Aron
- Subjects
Pulmonary and Respiratory Medicine ,Arterial inflow ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Arterial cannulation ,law.invention ,Transcatheter Aortic Valve Replacement ,Valve replacement ,law ,Internal medicine ,Catheterization, Peripheral ,medicine ,Cardiopulmonary bypass ,Humans ,Aged ,Aged, 80 and over ,Salvage Therapy ,Cardiopulmonary Bypass ,business.industry ,Surgery ,Peripheral ,medicine.anatomical_structure ,Ventricle ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Hemodynamic instability - Abstract
Hemodynamic instability during transcatheter aortic valve replacement procedures may require transient cardiopulmonary bypass for support. In patients with severe atherosclerosis, peripheral cannulation may not be possible. This method of direct left ventricle cannulation during transapical TAVR is a facile means to provide arterial inflow.
- Published
- 2014
84. Combined Treatment of Traumatic Aortic Transection and Kommerell Diverticulum
- Author
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Derek R. Brinster and Cameron R. Smith
- Subjects
Pulmonary and Respiratory Medicine ,Kommerell diverticulum ,medicine.medical_specialty ,Trauma patient ,medicine.diagnostic_test ,business.industry ,Computed tomography ,Emergency department ,General Medicine ,Vehicle accident ,surgical procedures, operative ,Combined treatment ,cardiovascular system ,Medicine ,Surgery ,cardiovascular diseases ,Radiology ,business ,Cardiology and Cardiovascular Medicine - Abstract
We present the case of a 41-year-old male trauma patient admitted to the emergency department after being struck in a pedestrian versus a motor vehicle accident. Computed tomography revealed a traumatic transaction of the descending aorta with pseudoaneurysm and an aberrant right subclavian artery with Kommerell diverticulum. Surgical correction was accomplished with bilateral subclavian carotid bypass, with occlusion of both subclavian arteries followed by the placement of endovascular stent grafts to repair the aortic injury.
- Published
- 2010
85. Minimally Invasive Technique for Iliac Revascularization after Large-Bore Sheath Traumatic Avulsion
- Author
-
Derek R. Brinster
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aorta ,Percutaneous ,Cardiothoracic surgeons ,business.industry ,medicine.medical_treatment ,General Medicine ,Revascularization ,Aortic disease ,Surgery ,Avulsion ,medicine.artery ,cardiovascular system ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Percutaneous treatments of cardiac valvular and thoracic aortic diseases are rapidly progressing. To maintain an indispensable part of their treatment, cardiothoracic surgeons must evolve to be able to handle all complications related to the use of percutaneous devices. One of the most common complications is vascular access disruption. Presented here is a method for a combined surgical and endovascular treatment for minimally invasive repair of an iliac artery avulsion.
- Published
- 2009
86. Effectiveness of Same Day Percutaneous Coronary Intervention Followed by Minimally Invasive Aortic Valve Replacement for Aortic Stenosis and Moderate Coronary Disease ('Hybrid Approach')
- Author
-
Gregory S. Couper, Daniel I. Simon, Donald S. Baim, Campbell Rogers, Derek R. Brinster, Margaretta Byrne, and Lawrence H. Cohn
- Subjects
Male ,medicine.medical_specialty ,Ticlopidine ,medicine.medical_treatment ,Coronary Disease ,Coronary artery disease ,Aortic valve replacement ,Internal medicine ,Angioplasty ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Prospective Studies ,cardiovascular diseases ,Heart valve ,Aged ,Aged, 80 and over ,Aspirin ,business.industry ,Percutaneous coronary intervention ,Stent ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,Clopidogrel ,Surgery ,Coronary arteries ,medicine.anatomical_structure ,Elective Surgical Procedures ,Aortic Valve ,Conventional PCI ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
In 2005, the investigators described a "hybrid" cardiovascular interventional strategy combining percutaneous coronary intervention (PCI) for coronary artery disease (CAD) followed by valve surgery for patients with urgent complex CAD and valve disease to reduce morbidity and mortality. This hybrid approach has been extended prospectively in elderly, high-risk patients with aortic stenosis scheduled for elective minimally invasive aortic valve replacement (MI-AVR) who, on preoperative coronary angiography, were found to have moderate CAD amenable to PCI. In this prospective, observational series, 18 patients (mean age 76 years) underwent elective hybrid MI-AVR with PCI from May 2003 to February 2006. Five patients had undergone previous coronary artery bypass grafting. Patients underwent coronary angiography the day of (n = 12) or evening before (n = 6) MI-AVR, and after identifying moderately severe CAD, all 18 underwent the implantation of drug-eluting stents to the affected coronary arteries, followed by MI-AVR. Although all patients received standard doses of antiplatelet medications, including acetylsalicylic acid (325 mg before PCI and 325 mg/day thereafter) and clopidogrel (300 mg after PCI, 75 mg/day thereafter for 90 days for the Cypher stent), there were no reoperations for bleeding; only 8 of 18 patients required postoperative blood transfusions. One patient died postoperatively from a colonic perforation, and there were no late mortalities after a mean follow-up of 19 months. In conclusion, this hybrid strategy has low morbidity and mortality and may be a new therapeutic option for older, high-risk patients with combined CAD and aortic valve disease.
- Published
- 2006
87. Endovascular treatment of a malpositioned screw in the thoracic aorta after anterior spinal instrumentation: the screwed aorta
- Author
-
Derek R. Brinster and Ayorinde Akinrinlola
- Subjects
musculoskeletal diseases ,Adult ,Male ,Reoperation ,medicine.medical_specialty ,Bone Screws ,Anterior spinal instrumentation ,Aorta, Thoracic ,Aortography ,Thoracic Vertebrae ,Fixation (surgical) ,Blood Vessel Prosthesis Implantation ,Internal medicine ,medicine.artery ,Intravascular ultrasound ,medicine ,Thoracic aorta ,Humans ,Orthopedic Procedures ,Endovascular treatment ,Ultrasonography, Interventional ,Aorta ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,General Medicine ,Vascular System Injuries ,musculoskeletal system ,equipment and supplies ,Surgery ,Blood Vessel Prosthesis ,Treatment Outcome ,Cardiology ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
An interesting case report detailing the management of an aorta that was inadvertently screwed during spinal fixation. The management and imaging encompass the use of computer tomography and intravascular ultrasound to determine the trajectory of the screw and the successful management of the patient.
- Published
- 2013
88. Synchronous colon and pancreatic cancers in a patient with Peutz-Jeghers syndrome: Report of a case and review of the literature
- Author
-
Derek R. Brinster and Steven E. Raper
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Pathology ,Colorectal cancer ,Peutz-Jeghers Syndrome ,Rectum ,Peutz–Jeghers syndrome ,Adenocarcinoma ,Gastroenterology ,Pancreaticoduodenectomy ,Neoplasms, Multiple Primary ,Hamartomatous Polyp ,Internal medicine ,medicine ,Humans ,skin and connective tissue diseases ,Colectomy ,Aged ,Gastrointestinal tract ,business.industry ,Colonoscopy ,medicine.disease ,digestive system diseases ,Pancreatic Neoplasms ,Bowel obstruction ,Treatment Outcome ,medicine.anatomical_structure ,Colonic Neoplasms ,Female ,Surgery ,Tomography, X-Ray Computed ,Pancreas ,business - Abstract
PEUTZ-JEGHERS SYNDROME (PJS) IS A RARE autosomal dominant disorder characterized by the development of hamartomatous polyps of the gastrointestinal tract and mucocutaneous lesions of the lips, buccal mucosa, and digits.1-3 PJS also causes multiple hamartomatous polyps in the small bowel (78%), stomach (38%), colon (42%), and rectum (28%).5 Although the main complication of PJS is intussusception of these lesions and subsequent bowel obstruction, patients with PJS have an estimated lifetime cancer risk 10 to 18 times greater than the general population.4,5 This increased risk of cancer is found in both gastrointestinal and extraintestinal sites and includes the stomach, duodenum, small intestine, colon, rectum, pancreas, breast, ovaries, and testis.6 The most common sites for gastrointestinal malignancy to occur are the colon and duodenum.7 We report the case of a patient with PJS treated with resection of synchronous pancreatic and colon cancers. This case report highlights the recent developments regarding the link between PJS and adenocarcinoma of the gastrointestinal tract.
- Published
- 2004
89. MINIMALLY-INVASIVE, ALTERNATIVE ACCESS APPROACH TO TAVR UTILIZING THE TRANSINNOMINATE ARTERY
- Author
-
Chad Kliger, Jacob Scheinerman, Derek R. Brinster, Luigi Pirelli, Alicia Adams, Efstathia Mihelis, and Dillon Weiss
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,medicine.disease ,Tortuosity ,Surgery ,medicine.anatomical_structure ,Valve replacement ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Artery ,Calcification - Abstract
Transfemoral approach to transcatheter aortic valve replacement (TAVR) has been the preferred access for valve introduction and deployment. When iliofemoral anatomy is prohibitive, either due to severe calcification and/or tortuosity, alternative access requires consideration; options include
- Published
- 2016
90. Aggressive progression of penetrating atheromatous ulcer of the descending thoracic aorta
- Author
-
John D. Grizzard, C. Sai Krishna, and Derek R. Brinster
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic Diseases ,Aorta, Thoracic ,Pseudoaneurysm ,Penetrating atherosclerotic ulcer ,medicine.artery ,medicine ,Thoracic aorta ,Humans ,cardiovascular diseases ,Ulcer ,Hematoma ,business.industry ,Stent ,Middle Aged ,medicine.disease ,Surgery ,Radiography ,surgical procedures, operative ,Treatment Outcome ,cardiovascular system ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The treatment of acute aortic pathologies continues to evolve with enhanced imaging capabilities. This case report highlights the rapid progression of penetrating atherosclerotic ulcer to pseudoaneurysm development and subsequent treatment with thoracic endovascular stent graft.
- Published
- 2012
91. Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion
- Author
-
Derek R. Brinster, Zain Khalpey, Patrick Olivier Myers, Ann Maloney, Lawrence H. Cohn, and Michael N. D'Ambra
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Transesophageal echocardiogram ,law.invention ,law ,Recurrence ,Risk Factors ,Internal medicine ,Mitral valve ,medicine ,Cardiopulmonary bypass ,Humans ,Mitral Valve Stenosis ,Aged ,Retrospective Studies ,Mitral valve repair ,Mitral regurgitation ,Chi-Square Distribution ,Mitral Valve Prolapse ,medicine.diagnostic_test ,ddc:617 ,business.industry ,Operative mortality ,Suture Techniques ,Mitral Valve Insufficiency ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Cardiology ,Mitral Valve ,Female ,business ,Cardiology and Cardiovascular Medicine ,Echocardiography, Transesophageal - Abstract
BackgroundThe edge-to-edge technique has been proposed to prevent systolic anterior motion (SAM) of the mitral valve. There is limited clinical data available on outcomes of this technique for this indication. We reviewed the midterm results of this technique for SAM prevention and treatment.MethodsA total of 2226 patients had mitral valve repair between 2000 and 2011, 1148 of which were for myxomatous mitral regurgitation. Beginning in 2000, predictability of postrepair SAM based on the prebypass, intraoperative transesophageal echocardiogram arose in our program. The edge-to-edge technique was used in 65 patients (5.7%) for SAM management, in 53 patients preemptively for transesophageal echocardiogram-based SAM prediction, and in 12 patients for postrepair SAM treatment.ResultsThere was no operative mortality. Postoperative mitral regurgitation was significantly improved in all patients compared with the preoperative grade (P
- Published
- 2012
92. Invited commentary
- Author
-
Derek R. Brinster
- Subjects
Pulmonary and Respiratory Medicine ,Male ,Blood Vessel Prosthesis Implantation ,Aortic Valve ,Replantation ,Aortic Diseases ,Humans ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,Coronary Vessels - Published
- 2011
93. Removal of Arterial Lines and Devices from the Ascending Aorta in Cardiac Surgery Patients
- Author
-
Derek R. Brinster and Shideh Chinichian
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aorta ,Percutaneous ,Heart Diseases ,business.industry ,Endovascular Procedures ,Closure (topology) ,General Medicine ,Cardiac surgery ,Catheters, Indwelling ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Cardiology ,Humans ,Surgery ,Postoperative Period ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Device Removal ,Monitoring, Physiologic - Abstract
The use of monitoring or device lines through the ascending aorta may be necessary for a variety of clinical situations. The technique provided in this article allows percutaneous closure of these entry sites with a closed chest.
- Published
- 2014
94. Open heart surgery for removal of polymethylmethacrylate after percutaneous vertebroplasty
- Author
-
Alok Dash and Derek R. Brinster
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Vena cava ,medicine.medical_treatment ,Vena Cava, Inferior ,Vena caval ,Percutaneous vertebroplasty ,medicine ,Humans ,Polymethyl Methacrylate ,cardiovascular diseases ,Thrombus ,Aged ,Venous Thrombosis ,Vertebroplasty ,business.industry ,Bone Cements ,medicine.disease ,Surgery ,Vertebra ,Cardiac surgery ,medicine.anatomical_structure ,Circulatory system ,cardiovascular system ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
We describe a 73-year-old woman who had a right atrial-inferior vena caval thrombus and pulmonary thromboembolism develop after percutaneous vertebroplasty with methylmethacrylate. Our patient subsequently underwent open-heart surgery to effectively remove the bulk of the foreign material. This case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt diagnosis and treatment.
- Published
- 2010
95. Invited commentary
- Author
-
Derek R. Brinster
- Subjects
Pulmonary and Respiratory Medicine ,Aortic Dissection ,Aortic Aneurysm, Thoracic ,Cerebrovascular Circulation ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Brachiocephalic Trunk ,Blood Vessel Prosthesis ,Catheterization - Published
- 2009
96. Treatment of infolding related to the gore TAG thoracic endoprosthesis
- Author
-
Ivan C. Davis, Jaime Tisnado, Daniel A. Leung, Gundars Katlaps, M.K. Sydnor, Derek R. Brinster, and D.J. Komorowski
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic injury ,Aorta, Thoracic ,Arterial Occlusive Diseases ,Computed tomographic ,Blunt ,Medicine ,Postoperative phase ,Humans ,Radiology, Nuclear Medicine and imaging ,Aorta, Abdominal ,Surgical repair ,business.industry ,Accidents, Traffic ,Stent ,Middle Aged ,Type b dissection ,Magnetic Resonance Imaging ,Surgery ,Blood Vessel Prosthesis ,Prosthesis Failure ,cardiovascular system ,Wounds, Gunshot ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
The present report describes three cases of thoracic aortic endograft infolding or collapse involving the Gore TAG system. The cases include a penetrating aortic injury, a blunt aortic injury, and a symptomatic type B dissection. In the first case, infolding occurred in a delayed fashion after a normal-appearing 3-month follow-up computed tomographic angiogram. In the other two cases, infolding occurred during the immediate postoperative phase. One of the patients underwent explantation and surgical repair. The other two underwent endovascular repair of the infolded endograft by placement of a balloon-expandable stent in one case and a self-expanding stent in the other.
- Published
- 2007
97. Circumferential involvement of an acute type B aortic dissection: a unique case
- Author
-
Derek R. Brinster, J.V. Nixon, Robert G. Kayser, and Mark S. Parker
- Subjects
Aortic dissection ,Adult ,medicine.medical_specialty ,business.industry ,Type B aortic dissection ,medicine.disease ,Type b dissection ,Aortography ,Surgery ,Aortic Aneurysm ,Computed tomographic angiography ,Aortic Dissection ,Rare Diseases ,Acute type ,Acute Disease ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Aorta ,Echocardiography, Transesophageal - Abstract
A case of a 35-year-old woman with acute circumferential type B aortic dissection is presented. A review of the literature demonstrated that circumferential aortic dissection is limited to a small number of case reports and a small case series of type A lesions. This is the first report of a circumferential type B dissection. The case highlights the need to fully evaluate patients with acute aortic dissection and illustrates the unique data provided by transesophageal echocardiography and helical computed tomographic angiography.
- Published
- 2007
98. Endovascular treatment of a thoracic aortic pseudoaneurysm after previous open repair
- Author
-
Derek R. Brinster, Scott S. Berman, Dawn Olsen, Desirae M. McKee, and Julio A. Rodriguez‐Lopez
- Subjects
Pulmonary and Respiratory Medicine ,Thorax ,medicine.medical_specialty ,medicine.medical_treatment ,Pulsatile flow ,Aortic Diseases ,Catheterization ,Aneurysm ,Postoperative Complications ,Recurrence ,medicine.artery ,medicine ,Thoracic aorta ,Humans ,cardiovascular diseases ,Endovascular treatment ,Aged ,Aortic Aneurysm, Thoracic ,Vascular disease ,business.industry ,Stent ,medicine.disease ,Surgery ,Aortic Dissection ,surgical procedures, operative ,Thoracotomy ,Back Pain ,Hypertension ,cardiovascular system ,Female ,Stents ,Radiology ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,business ,Aneurysm, False ,Aortic Aneurysm, Abdominal - Abstract
The use of endovascular stents to treat descending thoracic aortic pathologies is emerging as a less invasive therapy to treat high-risk patients. This case report describes the presentation of a patient with a pulsatile mass on her back. The patient's computed tomographic scan revealed the mass to be an extension of a large psuedoaneurysm from the site of a previous repair of her thoracic aorta for a dissecting aneurysm several years earlier. The psuedoaneurysm was successfully treated with an endovascular stent and the patient was discharged home on postoperative day 5.
- Published
- 2005
99. Thoracic aortic stent grafts
- Author
-
Derek R. Brinster, Jeffrey P. Carpenter, Richard A. Baum, Joseph E. Bavaria, Ronald M. Fairman, Omaida C. Velazquez, and Ross Milner
- Subjects
medicine.medical_specialty ,Aortic Aneurysm, Thoracic ,business.industry ,Aorta, Thoracic ,Aortic stent ,Prosthesis Design ,Radiography, Interventional ,Surgery ,Catheterization ,Aortic Dissection ,Text mining ,Postoperative Complications ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stents ,business - Published
- 2001
100. New paradigms and improved results for the surgical treatment of acute type A dissection
- Author
-
Alison Escherich, Timothy J. Gardner, Michael L. McGarvey, Alberto Pochettino, Robert C. Gorman, Joseph E. Bavaria, Joseph H. Gorman, and Derek R. Brinster
- Subjects
Aortic arch ,Aortic valve ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,law.invention ,Aortic aneurysm ,Blood vessel prosthesis ,law ,Hypothermia, Induced ,medicine.artery ,Monitoring, Intraoperative ,medicine ,Cardiopulmonary bypass ,Scientific Papers ,Humans ,Cardiopulmonary resuscitation ,Cerebral perfusion pressure ,Aortic rupture ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cardiopulmonary Bypass ,business.industry ,Electroencephalography ,Middle Aged ,medicine.disease ,Surgery ,Aortic Aneurysm ,Blood Vessel Prosthesis ,Aortic Dissection ,medicine.anatomical_structure ,Anesthesia ,Female ,business ,Echocardiography, Transesophageal - Abstract
Objective To examine the effect of an integrated surgical approach to the treatment of acute type A dissections. Background Data Acute type A dissection requires surgery to prevent death from proximal aortic rupture or malperfusion. Most series of the past decade have reported a death rate in the range of 15% to 30%. Methods From January 1994 to March 2001, 104 consecutive patients underwent repair of acute type A dissection. All had an integrated operative management as follows: intraoperative transesophageal echocardiography; hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP) to replace the aortic arch; HCA established after 5 minutes of electroencephalographic (EEG) silence in neuromonitored patients (66%) or after 45 minutes of cooling in patients who were not neuromonitored (34%); reinforcement of the residual arch tissue with a Teflon felt neo-media; cannulation of the arch graft to reestablish cardiopulmonary bypass at the completion of HCA (antegrade graft perfusion); and remodeling of the sinus of Valsalva segments with Teflon felt neo-media and aortic valve resuspension (78%) or replacement with a biologic or mechanical valved conduit (22%). Results Mean age was 59 ± 15 (range 22-86) years, with 71% men and 13% redo sternotomy after a previous cardiac procedure. Mean cardiopulmonary bypass time was 196 ± 50 minutes. Mean HCA with RCP time was 42 ± 12 minutes (range 19-84). Mean cardiac ischemic time was 140 ± 45 minutes. Eleven percent of patients presented with a preoperative neurologic deficit, and 5% developed a new cerebrovascular accident after dissection repair. The in-hospital death rate was 9%. Excluding the patients who presented neurologically unresponsive or with ongoing cardiopulmonary resuscitation (n = 5), the death rate was 4%. In six patients adverse cerebral outcomes were potentially avoided when immediate surgical fenestration was prompted by a sudden change in the EEG during cooling. Forty-five percent of neuromonitored patients required greater than 30 minutes to achieve EEG silence. Conclusion The authors have shown that the surgical integration of sinus segment repair or aortic root replacement, the use of EEG monitoring, partial or total arch replacement using RCP, routine antegrade graft perfusion, and the uniform use of transesophageal echocardiography substantially decrease the death and complication rates of acute type A dissection repair.
- Published
- 2001
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