104 results on '"Ogami T"'
Search Results
2. High-frequency lamb wave device composed of MEMS structure using LiNb[O.sub.3] thin film and air gap
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Kadota, M., Ogami, T., Yamamoto, K., Tochishita, H., and Negoro, Y.
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Niobium -- Structure ,Dielectric films -- Structure ,Thin films -- Structure ,Lithium compounds -- Structure ,Business ,Electronics ,Electronics and electrical industries - Published
- 2010
3. Incidence and Cause of Persistent Low Flow Alarm after HeartMate 3 Left Ventricular Assist Device Insertion
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Ogami, T., primary, Naka, Y., additional, Sanchez, J., additional, Ning, Y., additional, Kurlansky, P., additional, Witer, L., additional, Kaku, Y., additional, Topkara, V., additional, Yuzefpolskaya, M., additional, Colombo, P., additional, Gabriel, S., additional, Uriel, N., additional, Takayama, H., additional, and Takeda, K., additional
- Published
- 2020
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4. Space Weathering Products Found on the Surfaces of the Itokawa Dust Particles: A Summary of the Initial Analysis
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Noguchi, T, Kimura, M, Hashimoto, T, Konno, M, Nakamura, T, Ogami, T, Ishida, H, Sagae, R, Tsujimoto, S, Tsuchiyama, A, Zolensky, M. E, Tanaka, M, Fujimura, A, Abe, M, Yada, T, Mukai, T, Ueno, M, Okada, T, Shirai, K, Ishibashi, Y, and Okazaki, R
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Lunar And Planetary Science And Exploration - Abstract
Surfaces of airless bodies exposed to interplanetary space gradually have their structures, optical properties, chemical compositions, and mineralogy changed by solar wind implantation and sputtering, irradiation by galactic and solar cosmic rays, and micrometeorite bombardment. These alteration processes and the resultant optical changes are known as space weathering [1, 2, 3]. Our knowledge of space weathering has depended almost entirely on studies of the surface materials returned from the Moon and regolith breccia meteorites [1, 4, 5, 6] until the surface material of the asteroid Itokawa was returned to the Earth by the Hayabusa spacecraft [7]. Lunar soil studies show that space weathering darkens the albedo of lunar soil and regolith, reddens the slopes of their reflectance spectra, and attenuates the characteristic absorption bands of their reflectance spectra [1, 2, 3]. These changes are caused by vapor deposition of small (<40 nm) metallic Fe nanoparticles within the grain rims of lunar soils and agglutinates [5, 6, 8]. The initial analysis of the Itokawa dust particles revealed that 5 out of 10 particles have nanoparticle-bearing rims, whose structure varies depending on mineral species. Sulfur-bearing Fe-rich nanoparticles (npFe) exist in a thin (5-15 nm) surface layer (zone I) on olivine, low-Ca pyroxene, and plagioclase, suggestive of vapor deposition. Sulfur-free npFe exist deeper inside (<60 nm) ferromagnesian silicates (zone II). Their texture suggests formation by amorphization and in-situ reduction of Fe2+ in ferromagnesian silicates [7]. On the other hand, nanophase metallic iron (npFe0) in the lunar samples is embedded in amorphous silicate [5, 6, 8]. These textural differences indicate that the major formation mechanisms of the npFe0 are different between the Itokawa and the lunar samples. Here we report a summary of the initial analysis of space weathering of the Itokawa dust particles.
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- 2012
5. Mineralogy and Major Element Abundance of the Dust Particles Recovered from Muses-C Regio on the Asteroid Itokawa
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Nakamura, T, Noguchi, T, Tanaka, M, Zolensky, M. E, Kimura, M, Nakato, A, Ogami, T, Ishida, H, Tsuchiyama, A, Yada, T, Shirai, K, Okazaki, R, Fujimura, A, Ishibashi, Y, Abe, M, Okada, T, Ueno, M, and Mukai, T
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Geophysics - Abstract
Remote sensing by the spacecraft Hayabusa suggested that outermost surface particles of Muses-C regio of the asteroid Itokawa consist of centimeter and sub-centimeter size small pebbles. However, particles we found in the sample catcher A stored in the Hayabusa capsule, where Muses-C particles were captured during first touchdown, are much smaller. i.e., most are smaller than 100 microns in size. This suggests that only small fractions of Muses-C particles were stirred up due to the impact of the sampling horn onto the surface, or due to jets from chemical thrusters during the lift off of the spacecraft from the surface. X-ray fluorescence and near-infrared measurements by the Hayabusa spacecraft suggested that Itokawa surface materials have mineral and major element composition roughly similar to LL chondrites. The particles of the Muses-C region are expected to have experienced some effects of space weathering. Both of these prospects can be tested by the direct mineralogical analyses of the returned Itokawa particles in our study and another one. This comparison is most important aspect of the Hayabusa mission, because it finally links chemical analyses of meteorites fallen on the Earth to spectroscopic measurements of the asteroids.
- Published
- 2011
6. SEM and TEM Observation of the Surfaces of the Fine-Grained Particles Retrieved from the Muses-C Regio on the Asteroid 25413 Itokawa
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Noguchi, T, Nakamura, T, Zolensky, Michael E, Tanaka, M, Hashimoto, T, Konno, M, Nakato, A, Ogami, T, Fujimura, A, Abe, M, Yada, T, Mukai, T, Ueno, M, Okada, T, Shirai, K, Ishibashi, Y, and Okazaki, R
- Subjects
Astrophysics - Abstract
Surface materials on airless solar system bodies exposed to interplanetary space are gradually changed their visible to near-infrared reflectance spectra by the process called "space weathering", which makes the spectra darker and redder. Hapke et al. proposed a model of space weathering: vapor deposition of nanophase reduced iron (npFe(sup 0)) on the surfaces of the grains within the very surface of lunar regolith. This model has been proved by detailed observation of the surfaces of the lunar soil grains by transmission electron microscope (TEM). They demonstrated that npFe(sup 0) was formed by a combination of vapor deposition and irradiation effects. In other words, both micrometeorite impacts and irradiation by solar wind and galactic cosmic ray play roles on the space weathering on the Moon. Because there is a continuum of reflectance spectra from those of Q-type asteroids (almost the same as those of ordinary chondrites) to those of S-type asteroids, it is strongly suggested that reflectance spectra of asteroids composed of ordinary chondrite-like materials were modified over time to those of S-type asteroids due to space weathering. It is predicted that a small amount of npFe(sup 0) on the surface of grains in the asteroidal regolith composed of ordinary chondrite-like materials is the main agent of asteroidal space weathering.
- Published
- 2011
7. Analytical dual-energy microtomography: A new method for obtaining three-dimensional mineral phase images and its application to Hayabusa samples
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Tsuchiyama, A., primary, Nakano, T., additional, Uesugi, K., additional, Uesugi, M., additional, Takeuchi, A., additional, Suzuki, Y., additional, Noguchi, R., additional, Matsumoto, T., additional, Matsuno, J., additional, Nagano, T., additional, Imai, Y., additional, Nakamura, T., additional, Ogami, T., additional, Noguchi, T., additional, Abe, M., additional, Yada, T., additional, and Fujimura, A., additional
- Published
- 2013
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8. High frequency lamb wave resonator using LiNbO3 crystal thin plate and application to tunable filter.
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Kadota, M. and Ogami, T.
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- 2010
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9. Coustic filter and resonator on periodical poled LiTaO3.
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Kadota, M., Ogami, T., Yamamoto, K., and Cho, Y.
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- 2009
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10. 4.5 GHz Lamb wave device composed of LiNbO3 thin film.
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Kadota, M., Ogami, T., Yamamoto, K., Negoro, Y., and Tochishita, H.
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- 2009
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11. Acoustic wave devices using periodical poled Z-cut LiTaO3 plate.
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Kadota, M., Ogami, T., Yamamoto, K., and Yasuo Cho
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- 2009
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12. High frequency lamb wave resonator using LiNbO3 thin film by CVD.
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Kadota, M., Ogami, T., Yamamoto, K., and Tochishita, H.
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- 2009
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13. High frequency Lamb wave device composed of LiNbO3 thin film.
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Kadota, M., Ogami, T., Yamamoto, K., Negoro, Y., and Tochishita, H.
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- 2008
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14. Hypertensive Patients and their Dental Observations
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Ichiki M, Shiroiwa T, Onuki S, Yamada Y, and Ogami T
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General Medicine - Published
- 1967
15. A case of HIV coinfected with hepatitis B virus treated by entecavir
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Yamada, A., Akahito Sako, Nishimura, S., Nakashima, R., Ogami, T., Fujiya, K., Tsuda, N., Asayama, N., Yada, T., Shirai, K., Akazawa, N., Sakurai, T., Yago, Y., Nagata, N., Oshima, T., Yokoi, C., Sasajima, K., Kobayakawa, M., Akiyama, J., Imamura, M., Yanase, M., Uemura, N., and Masaki, N.
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Male ,Guanine ,Humans ,RNA, Viral ,HIV Infections ,Homosexuality ,Middle Aged ,Hepatitis B ,Antiviral Agents - Abstract
A 45-year-old male active homosexual was given a diagnosis of HIV-1 and acute hepatitis B in August 2007. Since his liver function became rapidly impaired, anti-HBV therapy with oral administration of entecavir (ETV) was started, and resulted in a favorable outcome. However, serum concentration of HIV-RNA decreased by log 1.26 within 60 days, which strongly suggested the inhibition of HIV proliferation by ETV. To prevent the appearance of mutated HIV, novel therapeutic strategies should be established in HIV/HBV-coinfected patients.
16. Problems in point-contact tunneling study on BSCCO
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Murakami, H., Ogami, T., Qi, Y., Sakai, K., Ito, T., Shigaki, I., Jansen, A. G., and Wyder, P.
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- 2000
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17. Fabrication of a variable low-temperature STM unit
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Murakami, H., Ogami, T., Qi, Y., Sakai, K., and Ito, T.
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- 2000
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18. Phase-specific survival after endovascular versus open surgical repair of descending thoracic aortic aneurysm.
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Iyanna N, Ogami T, Yokoyama Y, Takagi H, Serna-Gallegos D, Chu D, Sultan I, and Kuno T
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- Humans, Treatment Outcome, Time Factors, Risk Factors, Risk Assessment, Male, Female, Aged, Middle Aged, Postoperative Complications mortality, Postoperative Complications etiology, Descending Thoracic Aortic Aneurysm, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic mortality, Aortic Aneurysm, Thoracic diagnostic imaging, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality
- Abstract
Introduction: Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings., Evidence Acquisition: A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes. The search was performed up until March 2023., Evidence Synthesis: Eight studies met the inclusion criteria, including 4 studies using propensity-score matching and four studies reporting risk-adjusted outcomes, comprising 14,873 patients with DTA undergoing OSR (N.=10,882) and TEVAR (N.=3991). Operative mortality was similar between the two interventions (odds ratio 0.92, 95% CI 0.70-1.21, P=0.57, I
2 =0%). However, overall long-term mortality was significantly higher after TEVAR compared to OSR (Hazard Ratio [HR] 1.30, 95% CI 1.05-1.59, P=0.01, I2 =0%). Phase-specific analysis revealed comparable risks of mortality within 1 year and between one and two years after interventions, while the risk of mortality was significantly higher after TEVAR compared to OSR beyond two years (HR 1.77, 95% CI, 1.19-2.63, P=0.01. I2 =0%)., Conclusions: This study demonstrated comparable operative mortality between OSR and TEVAR, but higher long-term mortality associated with TEVAR in patients with DTA. The phase-specific analysis highlighted the survival advantage of OSR beyond 2 years. These findings suggest a need for reconsidering OSR indications in the management of DTA.- Published
- 2024
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19. Readmission-related outcomes of surgical versus transcatheter aortic valve replacement in patients aged 65 or older with bicuspid aortic valve.
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Ogami T, Yousef S, Brown JA, Kliner DE, Toma C, Serna-Gallegos D, Doshi N, Wang Y, and Sultan I
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- Humans, Male, Female, Aged, Treatment Outcome, Time Factors, Aged, 80 and over, Risk Factors, United States, Retrospective Studies, Age Factors, Risk Assessment, Postoperative Complications etiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Patient Readmission, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Transcatheter Aortic Valve Replacement economics, Bicuspid Aortic Valve Disease surgery, Bicuspid Aortic Valve Disease diagnostic imaging, Bicuspid Aortic Valve Disease mortality, Bicuspid Aortic Valve Disease physiopathology, Aortic Valve surgery, Aortic Valve abnormalities, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Databases, Factual, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Heart Valve Prosthesis Implantation economics, Heart Valve Diseases surgery, Heart Valve Diseases mortality, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology
- Abstract
Background: There continues to be debate regarding the superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valves (BAV). We aimed to compare outcomes during readmissions in elderly patients with BAV who underwent SAVR or TAVR., Methods: Patients 65 years or older with BAV who underwent TAVR or isolated SAVR were identified using the National Readmission Database from 2012 through 2018. We compared outcomes during readmissions within 90 days after discharge from the index surgery. Propensity score matching was performed to adjust the baseline differences., Results: During the study period, 8555 and 1081 elderly patients with BAV underwent SAVR and TAVR, respectively. The number of patients who underwent TAVR went up by 179 % from 2012 to 2018. Propensity score matching yielded 573 patients in each group. A total of 111 (19.4 %) in the SAVR group and 125 (21.8 %) in the TAVR group were readmitted within 90 days after the index surgery (p = .31). The mortality during the readmissions within 90 days was equivalent between the two groups (0.9 % in the SAVR group vs. 3.2 % in the TAVR group, p = .22). However, the median hospital cost was approximately doubled in the TAVR group during the readmission (18,250 dollars vs. 9310 dollars in the SAVR group, p < .001)., Conclusions: Readmission within 90 days was common in both groups. While the mortality during the readmissions after the surgery was equivalent between the two groups, hospital cost was significantly more expensive in the TAVR group., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: IS receives institutional research support from Abbott, Artivion, Atricure, Boston Scientific, Edwards Lifesciences, Medtronic, Terumo Aortic. None related to this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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20. Reinterventions After Repair of Acute Type A Aortic Dissection: Incidence, Outcomes, and Risk Factors.
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Brown JA, Yousef S, Garvey J, Ogami T, Serna-Gallegos D, Sá MP, Thoma F, Zhu J, Phillippi J, and Sultan I
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- Humans, Female, Male, Incidence, Middle Aged, Risk Factors, Aged, Retrospective Studies, Acute Disease, Treatment Outcome, Blood Vessel Prosthesis Implantation methods, Blood Vessel Prosthesis Implantation adverse effects, Follow-Up Studies, Aortic Dissection surgery, Aortic Dissection epidemiology, Aortic Dissection mortality, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic mortality, Reoperation statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Background: This study reports the incidence, outcomes, and risk factors for aortic reinterventions after repair of acute type A aortic dissection (ATAAD)., Methods: This was an observational study of aortic operations from 2010 to 2021. All patients with ATAAD undergoing open aortic arch reconstruction were included. Patients were dichotomized by the need for reintervention, which included reinterventions proximal to or distal to the index aortic repair. Propensity matching was used to determine the impact of reintervention on long-term outcomes. The cumulative incidence function for reintervention was estimated, and multivariable Fine-Gray analysis was performed to identify variables associated with reintervention, with death treated as a competing event., Results: We identified 601 patients undergoing surgery for ATAAD. An aortic reintervention was required in 71 (11.8%), comprising a proximal reintervention in 12 patients, a distal reintervention in 56, and both in 3. The cumulative incidence of reintervention was 11.6% (95% CI, 8.9%-14.6%) at 5 years and was 16.0% (95% CI, 12.2%-20.3%) at 10 years, with a median time to reintervention of 4.0 years (interquartile range, 0.9-7.5 years). Multivariable analysis using the Fine-Gray method showed no operative variables were associated with reinterventions. Among the 71 reinterventions, there were 4 (5.6%) operative deaths. After propensity matching, there was no difference in Kaplan-Meier survival estimates across each group (P = .138 by log-rank statistics)., Conclusions: The cumulative incidence of aortic reintervention after ATAAD repair was reasonably low (16% at 10 years), reinterventions were relatively safe (6% operative mortality), and reinterventions did not significantly impact long-term survival., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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21. Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection.
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Ogami T, Arnaoutakis GJ, Isselbacher EM, Geuzebroek GSC, Coselli JS, De Vincentiis C, Kaiser CA, Hutchison S, Li QG, Brinster DR, Leshnower BG, Serna-Gallegos D, Pai CW, Taylor BS, Patel HJ, Eagle KA, and Sultan I
- Abstract
Objective: With an aging population and advancements in imaging, recurrence of thoracic aortic dissection is becoming more common., Methods: All patients enrolled in the International Registry of Aortic Dissection from 1996 to 2023 with type A and type B acute aortic dissection were identified. Among them, initial dissection and recurrent dissection were discerned. The study period was categorized into 3 eras: historic era, 1996 to 2005; middle era, 2006 to 2015; most recent era, 2016 to 2023. Propensity score matching was applied between initial dissection and recurrent dissection. Outcome of interests included long-term survival and cumulative incidence of major aortic events defined by the composite of reintervention, aortic rupture, and new dissection., Results: The proportion of recurrent dissection increased from 5.9% in the historic era to 8.0% in the most recent era in the entire dissection cohort. In patients with type A dissection, propensity score matching between initial dissection and recurrent dissection yielded 326 matched pairs. Kaplan-Meier curves showed similar long-term survival between the 2 groups. However, the cumulative incidence of major aortic events was significantly higher in the recurrent dissection group (40.3% ± 6.2% vs 17.8% ± 5.1% at 4 years in the initial dissection group, P = .02). For type B dissection, 316 matched pairs were observed after propensity score matching. Long-term survival and the incidence of major aortic events were equivalent between the 2 groups., Conclusions: The case volume of recurrent dissection or the ability to detect recurrent dissection has increased over time. Acute type A recurrent dissection was associated with a higher risk of major aortic events than initial dissection. Further judicious follow-up may be crucial after type A recurrent dissection., Competing Interests: Conflict of Interest Statement G.J.A. receives consulting fees from Terumo Aortic. I.S. receives institutional research support from Abbott, AtriCure, Artivion, Boston Scientific, Edwards, Medtronic, and Terumo Aortic. None were related to this manuscript. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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22. The impact of reoperative surgery on aortic root replacement in the United States.
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Ogami T, Serna-Gallegos D, Arnaoutakis GJ, Chu D, Ferdinand FD, Sezer A, Szeto WY, Grimm JC, and Sultan I
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- Adult, Humans, United States epidemiology, Treatment Outcome, Retrospective Studies, Aorta surgery, Sternotomy adverse effects, Reoperation, Aortic Valve surgery, Heart Valve Prosthesis Implantation adverse effects
- Abstract
Objective: Reoperative sternotomy is associated with poor outcomes after cardiac surgery. We aimed to investigate the impact of reoperative sternotomy on the outcomes after aortic root replacement., Methods: All patients who underwent aortic root replacement from January 2011 to June 2020 were identified using the Society of Thoracic Surgeons Adult Cardiac Surgery Database. We compared outcomes between patients who underwent first-time aortic root replacement with those with a history of sternotomy undergoing reoperative sternotomy aortic root replacement using propensity score matching. Subgroup analysis was performed among the reoperative sternotomy aortic root replacement group., Results: A total of 56,447 patients underwent aortic root replacement. Among them, 14,935 (26.5%) underwent reoperative sternotomy aortic root replacement. The annual incidence of reoperative sternotomy aortic root replacement increased from 542 in 2011 to 2300 in 2019. Aneurysm and dissection were more frequently observed in the first-time aortic root replacement group, whereas infective endocarditis was more common in the reoperative sternotomy aortic root replacement group. Propensity score matching yielded 9568 pairs in each group. Cardiopulmonary bypass time was longer in the reoperative sternotomy aortic root replacement group (215 vs 179 minutes, standardized mean difference = 0.43). Operative mortality was higher in the reoperative sternotomy aortic root replacement group (10.8% vs 6.2%, standardized mean difference = 0.17). In the subgroup analysis, logistic regression demonstrated that individual patient repetition of (second or more resternotomy) surgery and annual institutional volume of aortic root replacement were independently associated with operative mortality., Conclusions: The incidence of reoperative sternotomy aortic root replacement might have increased over time. Reoperative sternotomy is a significant risk factor for morbidity and mortality in aortic root replacement. Referral to high-volume aortic centers should be considered in patients undergoing reoperative sternotomy aortic root replacement., (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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23. Midterm Outcomes After Aortic Valve Neocuspidization (Ozaki Procedure) in Adults.
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Ogami T, Dufendach KA, Imran M, Thoma FW, Bonatti JO, Yoon PD, Kaczorowski DJ, Sultan I, Morell VO, and Chu D
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- Adult, Humans, United States, Middle Aged, Aged, Aortic Valve surgery, Treatment Outcome, Risk Factors, Transcatheter Aortic Valve Replacement methods, Heart Valve Prosthesis Implantation methods, Aortic Valve Stenosis surgery, Aortic Valve Insufficiency surgery, Aortic Valve Disease surgery
- Abstract
Background: Trileaflet aortic valve neocuspidization (AVN) using autologous pericardium (Ozaki procedure) is an emerging surgical treatment option for aortic valve diseases. Although excellent results have been reported from Japan, data pertaining to its use in the United States are sparse., Methods: All adult patients who underwent AVN (AVN group) or surgical aortic valve replacement (SAVR) with a bioprosthetic valve (SAVR group) between 2015 and 2022 were identified. Propensity score matching was used to adjust the baseline characteristics between the 2 groups., Results: A total of 101 patients underwent AVN, and 1816 patients underwent SAVR with a bioprosthetic valve. None in the AVN group required conversion to SAVR. Before matching, mean age in the AVN group was 68.5 ± 8.8 years, and 56 patients (55.4%) underwent concomitant procedures. Preoperatively, 3 (3%) had endocarditis. Bicuspid valve was observed in 38 (38.4%). None died at 30 days in the AVN group. The median follow-up duration was 3.2 years. After propensity score matching, the expected survival and freedom from at least moderate aortic regurgitation at 5 years was 91.7% ± 3.1% and 97.6% ± 1.7%, respectively. Propensity score matching yielded 77 patients in each group. The Kaplan-Meier curve demonstrated equivalent survival at 5 years between the 2 groups (P = .95). Additionally, freedom from at least moderate aortic regurgitation was comparable at 5 years (P = .23)., Conclusions: AVN can be safely performed for a variety of aortic valve diseases, with or without concomitant operations. AVN demonstrated similar midterm outcomes compared with SAVR with a bioprosthetic valve in the United States adult population., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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24. The Clinical Significance of Unplanned Coronary Artery Bypass Grafting in Aortic Root Replacement.
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Ogami T, Serna-Gallegos D, Yousef S, Brown JA, Thoma FW, Subramaniam K, Gelzinis TA, Bonatti JO, Kaczorowski DJ, Yoon PD, Chu D, and Sultan I
- Subjects
- Humans, Aortic Valve surgery, Clinical Relevance, Treatment Outcome, Coronary Artery Bypass adverse effects, Retrospective Studies, Risk Factors, Aortic Valve Stenosis surgery, Coronary Artery Disease complications
- Abstract
Objectives: Unexpected coronary artery bypass grafting (CABG) is occasionally required during aortic root replacement (ARR). However, the impact of unplanned CABG remains unknown., Design: A single-center, retrospective observational study., Setting: At university-affiliated tertiary hospital., Participants: All patients who underwent ARR from 2011 through 2022., Interventions: Aortic root replacement with or without unplanned CABG., Measurements and Main Results: A total of 795 patients underwent ARR. Among them, 131 (16.5%) underwent planned concomitant CABG, and 34 (4.3%) required unplanned CABG. The most common indication of unplanned CABG was ventricular dysfunction (33.3%), followed by disease pathology (25.6%), anatomy (15.4%), and surgical complications (10.3%). A vein graft to the right coronary artery was the most commonly performed bypass. Infective endocarditis and aortic dissection were observed in 27.8% and 12.8%, respectively. Prior cardiac surgery was seen in 40.3%. The median follow-up period was 4.3 years. Unplanned CABG was not associated with operative mortality (odds ratio [OR] 1.54, 95% CI 0.33-7.16, p = 0.58) or long-term mortality (hazard ratio 0.91, 95% CI 0.44-1.89, p = 0.81). Body surface area smaller than 1.7 was independently associated with an increased risk of unplanned CABG (OR 4.51, 95% CI 1.85-11.0, p < 0.001)., Conclusions: Unplanned CABG occurred in 4.3% of patients during ARR, but was not associated with operative mortality or long-term mortality. A small body surface area was a factor associated with unplanned CABG., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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25. Chronic kidney disease and polypharmacy as risk factors for recurrent falls in a nursing home population.
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Sarad N, Jannath SY, Ogami T, Khedr S, Omar H, Thorson T, and Kopp M
- Abstract
Background: It is known that nursing home patients who have sustained a previous fall are at a higher average risk for recurrent falls. Therefore, these patients require closer attention and monitoring for fall prevention., Methods: We conducted a retrospective review in our Level 1 Trauma Center, who sustained a ground-level fall in a nursing home from January 2017 to December 2018. Inclusion criteria involved patients aged 65 or older, admitted from nursing homes. Logistic regression analysis was performed to identify factors associated with recurrent fall., Results: A total of 445 patients were identified. Among them, 47 (10.6%) patients sustained recurrent falls, The median age was 83.3 years old and. The recurrent fall group was more likely to have chronic kidney disease (CKD) (27.1% vs. 13.1%, p = 0.02) and diabetes (47.9% vs. 31%, p = 0.02). The median number of medications taken by a patient was 8.78. Overall, 176 (39.5%) patients sustained any injury, and 25 (5.6%) patients died within the study period. The presence of CKD (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.15-4.76, p = 0.02) and polypharmacy (number of medications of 9 or above) (OR, 2.07; 95% CI, 1.12-3.82, p = 0.02) were independent risk factors for recurrent falls., Conclusions: CKD and polypharmacy were associated with a risk of recurrent falls among nursing home patients. The incidence of falls has a multifactorial etiology, and it is important to identify such risk factors to better prevent the morbidities and mortalities associated with fall-related injuries., Competing Interests: There is no conflict of interest to disclose that is either directly or indirectly related to the work that is described in this manuscript., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)
- Published
- 2023
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26. Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection.
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Ogami T, Arnaoutakis GJ, Patel HJ, Pai CW, Eagle KA, Trimarchi S, Serna-Gallegos D, and Sultan I
- Subjects
- Humans, Endovascular Aneurysm Repair, Treatment Outcome, Retrospective Studies, Risk Factors, Postoperative Complications etiology, Postoperative Complications surgery, Blood Vessel Prosthesis Implantation adverse effects, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic complications, Endovascular Procedures adverse effects, Aortic Dissection diagnostic imaging, Aortic Dissection surgery, Acute Kidney Injury diagnosis, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Renal Insufficiency, Chronic complications
- Abstract
Background: Thoracic endovascular aortic repair (TEVAR) has evolved as the standard for treating complicated acute type B aortic dissection (ATBAD). Acute kidney injury (AKI) is a common complication in critically ill patients and is commonly observed in patients with ATBAD. The purpose of the study was to characterize AKI after TEVAR., Methods: All patients who underwent TEVAR for ATBAD from 2011 through 2021 were identified using the International Registry of Acute Aortic Dissection. The primary end point was AKI. A generalized linear model analysis was performed to identify a factor associated with postoperative AKI., Results: A total of 630 patients presented with ATBAD and underwent TEVAR. The indication for TEVAR was complicated ATBAD in 64.3%, high-risk uncomplicated ATBAD in 27.6%, and uncomplicated ATBAD in 8.1%. Of 630 patients, 102 (16.2%) developed postoperative AKI (AKI group) and 528 patients (83.8%) did not (non-AKI group). The most common indication for TEVAR was malperfusion (37.5%). In-hospital mortality was significantly higher in the AKI group (18.6% vs 4%; P < .001). Postoperatively, cerebrovascular accident, spinal cord ischemia, limb ischemia, and prolonged ventilation were more commonly observed in the AKI group. The expected mortality was similar at 2 years between the two groups (P = .51). Overall, the preoperative AKI was observed in 95 (15.7%) in the entire cohort consisting of 60 (64.5%) in the AKI group and 35 (6.8%) in the non-AKI group. A history of CKD (odds ratio, 4.6; 95% confidence interval, 1.5-14.1; P = .01) and preoperative AKI (odds ratio, 24.1; 95% confidence interval, 10.6-55.0; P < .001) were independently associated with postoperative AKI., Conclusions: The incidence of postoperative AKI was 16.2% in patients undergoing TEVAR for ATBAD. Patients with postoperative AKI had a higher rate of in-hospital morbidities and mortality than those without. A history of CKD and preoperative AKI were independently associated with postoperative AKI., (Published by Elsevier Inc.)
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- 2023
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27. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Concomitant Aortic Regurgitation.
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Yousef S, Bianco V, Kliner D, Toma C, Serna-Gallegos D, West D, Makani A, Zhu J, Thoma FW, Brown JA, Ogami T, and Sultan I
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- Humans, Aortic Valve surgery, Treatment Outcome, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Insufficiency complications, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis complications, Aortic Valve Stenosis surgery, Heart Valve Prosthesis adverse effects
- Abstract
Background: This study sought to evaluate outcomes of transcatheter aortic valve replacement (TAVR) in patients with moderate or greater aortic regurgitation (AR)., Methods: This was an observational study using an institutional database of TAVRs from November 2012 to April 2022. The study compared outcomes of TAVR in patients with isolated aortic stenosis (AS) vs patients with AS and concomitant AR (moderate or greater). Those patients with trace or mild AR were excluded. Clinical and echocardiographic outcomes were compared, with end points established by the Valve Academic Research Consortium 3. Kaplan-Meier survival estimation and Cox regression for mortality were performed. Competing-risk cumulative incidence estimates for heart failure readmissions were also compared., Results: Of 3295 patients, 605 (53.4%) had severe AS with no AR and 529 (46.6%) had severe AS with moderate or severe AR. There were no significant differences in in-hospital mortality, length of stay, stroke, myocardial infarction, permanent pacemaker requirement, transfusion requirement, minor or major vascular complications, or 30-day readmissions between the 2 groups (P > .05). There were also no significant differences in annular dissection or rupture, coronary obstruction, or device embolization. Mean gradient and paravalvular leak rates at 30 days and 1 year were similar between the groups. Survival estimates were comparable, and, on multivariable Cox regression, mixed aortic valvular disease was not associated with an increased hazard of death as compared with isolated AS (hazard ratio, 1.01; 95% CI, 0.81-1.25; P = .962). Cumulative incidence estimates for heart failure readmissions were comparable between groups., Conclusions: TAVR can be safely performed in patients with mixed valvular disease, with outcomes comparable to those in isolated AS., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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28. Long-Term Outcomes of Patients With Carotid and Aortic Body Tumors.
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Verghis NM, Brown JA, Yousef S, Aranda-Michel E, Serna-Gallegos D, Levenson J, Ogami T, Diaz-Castrillon C, Thoma F, Singh M, and Sultan I
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- Humans, Aortic Bodies pathology, Kaplan-Meier Estimate, Retrospective Studies, Carotid Body Tumor diagnosis, Carotid Body Tumor surgery, Paraganglioma, Extra-Adrenal
- Abstract
Chemodectomas are tumors derived from parasympathetic nonchromaffin cells and are often found in the aortic and carotid bodies. They are generally benign but can cause mass-effect symptoms and have local or distant spread. Surgical excision has been the main curative treatment strategy. The National Cancer Database was reviewed to study all patients with carotid or aortic body tumors from 2004 to 2015. Demographic data, tumor characteristics, treatment strategies, and patient outcomes were examined, split by tumor location. Kaplan-Meier survival estimates were generated for both locations. In total, 248 patients were examined, with 151 having a tumor in the carotid body and 97 having a tumor in the aortic body. Many variables were similar between both tumor locations. However, aortic body tumors were larger than those in the carotid body (477.80 ± 477.58 mm vs 320.64 ± 436.53 mm, p = 0.008). More regional lymph nodes were positive in aortic body tumors (65.52 ± 45.73 vs 35.46 ± 46.44, p <0.001). There were more distant metastases at the time of diagnosis in carotid body tumors (p = 0.003). Chemotherapy was used more for aortic body tumors (p = 0.001); surgery was used more for carotid body tumors (p <0.001). There are slight differences in tumor characteristics and response to treatment. Surgical resection is the cornerstone of management, and radiation can often be considered. In conclusion, chemodectomas are generally benign but can present with metastasis and compressive symptoms that make understanding their physiology and treatment important., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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29. Outcomes of Root Enlargement vs Root Replacement for Aortic Stenosis.
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Yousef S, Serna-Gallegos D, Brown JA, Ogami T, Wang Y, Thoma FW, Chu D, Bonatti J, Kaczorowski D, Yoon P, and Sultan I
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- Humans, Retrospective Studies, Aortic Valve surgery, Prosthesis Design, Treatment Outcome, Heart Valve Prosthesis Implantation methods, Aortic Valve Stenosis, Heart Valve Prosthesis, Bioprosthesis
- Abstract
Background: Stentless aortic root replacement (ARR) and aortic root enlargement (ARE) are established strategies to avoid prosthesis-patient mismatch in patients with aortic stenosis (AS) and small annuli. We sought to compare outcomes of these 2 procedures., Methods: This was an observational study using an institutional database of aortic valve replacements from 2010 to 2021. The study compared patients who underwent ARE vs ARR for AS. Those with endocarditis or aortic aneurysms were excluded. Postoperative outcomes were compared between groups. Kaplan-Meier survival estimation and multivariable Cox regression for survival were performed. Cumulative incidence functions were generated for all-cause readmissions., Results: A total of 533 patients underwent either ARE or ARR for AS. Of these, 193 (36.2%) underwent ARE and 340 (63.8%) underwent ARR with a stentless xenograft. There were no significant differences in operative mortality, stroke, length of stay, or new-onset renal failure requiring dialysis. There were also no significant differences in aortic valve reintervention rates (3.1% vs 1.8%; P = .314). Patients in the ARR group had larger valves implanted, larger indexed effective orifice areas, lower rates of prosthesis-patient mismatch, and lower transprosthetic gradients (P < .001). Median follow-up was 5.02 (2.70-7.8) years. Kaplan-Meier survival estimates were comparable, and on multivariable Cox regression, ARR vs ARE was not significantly associated with an increased hazard of death (hazard ratio, 1.00; 95% CI, 0.69-1.45; P = .996). Cumulative incidence estimates for all-cause readmissions were also comparable between groups., Conclusions: ARE and stentless xenograft ARR for AS were associated with comparable postoperative complications, aortic valve reinterventions, freedom from readmission, and 5-year survival., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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30. Acute Coronary Syndrome After Transcatheter Aortic Valve Implantation (Results from Over 40,000 Patients).
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Ogami T, Kliner DE, Toma C, Sanon S, Smith AJC, Serna-Gallegos D, Wang Y, Makani A, Doshi N, Brown JA, Yousef S, and Sultan I
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- Male, Humans, Female, Risk Factors, Treatment Outcome, Aortic Valve surgery, Transcatheter Aortic Valve Replacement adverse effects, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome surgery, Heart Failure complications, Percutaneous Coronary Intervention methods, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Coronary Artery Disease surgery
- Abstract
Acute coronary syndrome (ACS) encompasses a broad category of presentations from unstable angina to ST-elevation myocardial infarctions. Most patients undergo coronary angiography upon presentation for diagnosis and treatment. However, the ACS management strategy after transcatheter aortic valve implantation (TAVI) may be complicated because of challenging coronary access. The National Readmission Database was reviewed to identify all patients who were readmitted with ACS within 90 days after TAVI between 2012 and 2018. Their outcomes were described between patients who were readmitted with ACS (ACS group) and without (non-ACS group). A total of 44,653 patients were readmitted within 90 days after TAVI. Among them, 1,416 patients (3.2%) were readmitted with ACS. The ACS group had a higher prevalence of men, diabetes, hypertension, congestive heart failure, peripheral vascular disease, and a history of percutaneous coronary intervention (PCI). In the ACS group, 101 patients (7.1%) developed cardiogenic shock, whereas 120 patients (8.5%) developed ventricular arrhythmias. Overall, 141 patients (9.9%) in the ACS group died during readmissions (vs 3.0% in the non-ACS group, p <0.001). Among the ACS group, PCI was performed in 33 (5.9%), whereas coronary bypass grafting was performed in 12 (0.82%). The factors associated with ACS readmission included a history of diabetes, congestive heart failure, chronic kidney disease, and PCI, and nonelective TAVI. Coronary artery bypass grafting was an independent factor related to in-hospital mortality during ACS readmission (odds ratio 11.9, 95% confidence interval 2.18 to 65.4, p = 0.004), whereas PCI was not (odds ratio 0.19, 95% confidence interval 0.03 to 1.44, p = 0.11). In conclusion, patients readmitted with ACS have significantly higher mortality compared with those readmitted without ACS. History of PCI is an independent factor associated with ACS after TAVI., Competing Interests: Disclosures Dr. Sultan reports a relation with Atricure, Artivion, Abbott, Cryolife, Medtronic, and Boston Scientific that includes his institution (UPMC) receives research support/funding grants. The remaining authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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31. Acute Kidney Injury in Patients Undergoing Surgery for Type A Acute Aortic Dissection.
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Arnaoutakis GJ, Ogami T, Patel HJ, Pai CW, Woznicki EM, Brinster DR, Leshnower BG, Serna-Gallegos D, Bekeredjian R, Sundt TM, Shaffer AW, Peterson MD, Geuzebroek GSC, Eagle KA, Trimarchi S, and Sultan I
- Subjects
- Humans, Retrospective Studies, Risk Factors, Aorta, Postoperative Complications etiology, Aortic Dissection surgery, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology
- Abstract
Background: Acute kidney injury (AKI) after repair of type A acute aortic dissection (TAAAD) has been shown to affect both short- and long-term outcomes. This study aimed to validate the impact of postoperative AKI on in-hospital and long-term outcomes in a large population of dissection patients presenting to multinational aortic centers. Additionally, we assessed risk factors for AKI including surgical details., Methods: Patients undergoing surgical repair for TAAAD enrolled in the International Registry of Acute Aortic Dissection database were evaluated to determine the incidence and risk factors for the development of AKI., Results: A total of 3307 patients were identified. There were 761 (23%) patients with postoperative AKI (AKI group) vs 2546 patients without (77%, non-AKI group). The AKI group had a higher rate of in-hospital mortality (n = 193, 25.4% vs n = 122, 4.8% in the non-AKI group, P < .001). Additional postoperative complications were also more common in the AKI group including postoperative cerebrovascular accident, reexploration for bleeding, and prolonged ventilation. Independent baseline characteristics associated with AKI included a history of hypertension, diabetes, chronic kidney disease, evidence of malperfusion on presentation, distal extent of dissection to abdominal aorta, and longer cardiopulmonary bypass time. Kaplan-Meier survival curves revealed decreased 5-year survival among the AKI group (P < .001)., Conclusions: AKI occurs commonly after TAAAD repair and is associated with a significantly increased risk of operative and long-term mortality. In this large study using the International Registry of Acute Aortic Dissection database, several factors were elucidated that may affect risk of AKI., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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32. Sex-Related Differences in Clinical Outcomes After Thoracic Endovascular Aortic Repair.
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Yousef S, Brown JA, Aranda-Michel E, Serna-Gallegos D, Wang Y, Ogami T, and Sultan I
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- Male, Humans, Female, Endovascular Aneurysm Repair, Retrospective Studies, Treatment Outcome, Endovascular Procedures adverse effects, Blood Vessel Prosthesis Implantation adverse effects, Aortic Aneurysm, Thoracic surgery, Aortic Dissection surgery
- Abstract
Background Thoracic endovascular aortic repair (TEVAR) has been increasingly used for the treatment of descending thoracic aortic aneurysms and dissections. This study sought to evaluate the influence of sex on outcomes after TEVAR. Methods and Results This was an observational study from the Nationwide Readmissions Database analyzing all patients who underwent TEVAR from 2010 to 2018. Sampling weights were used to generate national estimates. International Classification of Diseases-Clinical Modification codes were used to identify patients with thoracic aortic aneurysms or dissections who underwent TEVAR. Patients were dichotomized according to sex, and 1:1 propensity score matching was applied. Mixed model regression for in-hospital mortality and weighted logistic regression with bootstrapping for 30-day readmissions were performed. A supplemental analysis was performed according to pathology (aneurysm or dissection). A weighted total of 27 118 patients were identified. Propensity-matching yielded 5026 risk-adjusted pairs. Men were more likely to undergo TEVAR for type B aortic dissection, whereas women were more likely to undergo TEVAR for aneurysm. In-hospital mortality was roughly 5% and was equivalent in the matched groups. Men were more likely to have paraplegia, acute kidney injury, and arrhythmias, while women were more likely to require transfusions after TEVAR. There were no significant differences in myocardial infarction, heart failure, respiratory failure, spinal cord ischemia, mesenteric ischemia, stroke, or 30-day readmission between the matched groups. On regression analysis, sex was not an independent risk factor for in-hospital mortality. Female sex was, however, significantly associated with a decreased odds of 30-day readmission (odds ratio, 0.90 [95% CI, 0.87-0.92]; P <0.001). Conclusions Women are more likely to undergo TEVAR for aneurysms, while men are more likely to undergo TEVAR for type B aortic dissection. In-hospital mortality after TEVAR is comparable among men and women irrespective of indication. Female sex is independently associated with a reduced odds of 30-day readmission after TEVAR.
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- 2023
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33. Readmission with infective endocarditis within 90 days following transcatheter aortic valve implantation.
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Ogami T, Kliner DE, Toma C, Serna-Gallegos D, Wang Y, Brown JA, Yousef S, and Sultan I
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- Humans, United States epidemiology, Aged, 80 and over, Patient Readmission, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve surgery, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Endocarditis, Bacterial surgery, Endocarditis diagnosis, Endocarditis epidemiology, Endocarditis etiology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications
- Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) continues to be the most common modality of treating aortic stenosis in the United States. While infective endocarditis (IE) and its outcomes have been well documented after surgical aortic valve replacement, the incidence and outcomes of early IE after TAVI have not been well described., Methods: All patients who underwent TAVI from 2012 through 2018 were identified using the National Readmission Database. Among them, patients who underwent TAVI at the index admission and readmitted within 90 days were included. Patients who died or had IE during the index admission were excluded. Clinical outcomes were compared between patients readmitted with IE (IE group) and those without (non-IE group)., Results: A total of 168,283 patients were readmitted to a hospital within 90 days after TAVI. The median age of the IE group and non-IE group were 81 and 82 years old, respectively (p = 0.21). Of those, 525 (0.3%) were readmitted with IE. The median time from TAVI to readmission was 20 days. During readmissions, 11.6% of the IE group died while only 3.15% of the non-IE group experienced death (p < 0.001). The most common causative organism of IE was enterococcus (22.1%). Multivariable analysis revealed that congestive heart failure, cerebrovascular disease, dialysis, concomitant valve disease, Medicaid, and discharge to a facility were independently associated with readmission with IE within 90 days., Conclusion: The incidence of readmission with IE is low after TAVI. However, the mortality was markedly high during readmissions. Surgical intervention was rarely performed for IE during the first admission. Enterococcus was the most common organism observed in IE after TAVI., Disclosure: IS receives institutional research support from Abbott, Atricure, cryolife, and Medtronic. None related to this manuscript., Clinical Trial Registration: Not applicable., (© 2022 Wiley Periodicals LLC.)
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- 2023
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34. Proximal aortic repair in dialysis patients: A national database analysis.
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Ogami T, Zimmermann E, Zhu RC, Zhao Y, Ning Y, Kurlansky P, Stevens JS, Avgerinos DV, Patel VI, and Takayama H
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- Humans, Aged, Renal Dialysis adverse effects, Retrospective Studies, Treatment Outcome, Time Factors, Risk Factors, Postoperative Complications, Blood Vessel Prosthesis Implantation, Aortic Dissection surgery, Endovascular Procedures adverse effects, Aortic Aneurysm, Abdominal surgery
- Abstract
Objectives: Dialysis is a well-established risk factor for morbidity and mortality after cardiovascular procedures. However, little is known regarding the outcomes of proximal aortic surgery in this high-risk cohort., Methods: Perioperative (in-hospital or 30-day mortality) and 10-year outcomes were analyzed for all the patients who underwent open proximal aortic repair with the diagnosis of nonruptured thoracic aortic aneurysm (aneurysm, n = 325) or type A aortic dissection (dissection, n = 461) from 1987 to 2015 using the US Renal Data System database., Results: In patients with aneurysm, perioperative mortality was 12.6%. The 10-year mortality was 81% ± 3%. Age 65 years or more (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.03 to 1.78; P = .03), chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.01-2.82; P = .047), and Black race (HR, 1.46; 95% CI, 1.09-1.97; P = .01) were independently associated with worse 10-year mortality. In patients with dissection, perioperative mortality was 24.3% and 10-year mortality was 87.9% ± 2.2%. Age 65 years or more (HR, 1.49; 95% CI, 1.19-1.86; P < .001), congestive heart failure (HR, 1.39; 95% CI, 1.11-2.57; P = .004), and diabetes mellitus as the cause of dialysis (HR, 1.75; 95% CI, 1.2-2.57; P = .004) were independently associated with worse 10-year mortality. Black race (HR, 0.74; 95% CI, 0.6-0.92; P = .008) was associated with a better outcome., Conclusions: We described challenging perioperative and 10-year outcomes for dialysis patients undergoing proximal aortic repair. The present study suggests the need for careful patient selection in the elective repair of proximal aortic aneurysm for dialysis-dependent patients, whereas it affirms the feasibility of emergency surgery for acute type A aortic dissections., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2023
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35. Commentary: Choice of Prosthesis in the Hemodialysis Patient: Everything Old is New Again.
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Ogami T and Kurlansky P
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- Humans, Treatment Outcome, Prosthesis Implantation, Renal Dialysis, Blood Vessel Prosthesis
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- 2022
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36. Trends in Endovascular Management of Aberrant Subclavian Artery With Kommerell Diverticulum.
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Ogami T and Sultan I
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- Humans, Subclavian Artery diagnostic imaging, Subclavian Artery surgery, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Cardiovascular Abnormalities complications, Cardiovascular Abnormalities diagnostic imaging, Cardiovascular Abnormalities surgery, Aortic Arch Syndromes, Diverticulum complications, Diverticulum diagnostic imaging, Diverticulum surgery, Endovascular Procedures
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- 2022
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37. Minimally invasive versus conventional aortic valve replacement: The network meta-analysis.
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Ogami T, Yokoyama Y, Takagi H, Serna-Gallegos D, Ferdinand FD, Sultan I, and Kuno T
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- Humans, Aortic Valve surgery, Network Meta-Analysis, Treatment Outcome, Sternotomy, Minimally Invasive Surgical Procedures, Retrospective Studies, Heart Valve Prosthesis Implantation, Heart Valve Prosthesis, Aortic Valve Stenosis surgery
- Abstract
Background: Outcome comparisons after surgical aortic valve replacement (SAVR) with minimally invasive approaches including mini-sternotomy (MS) and right mini-thoracotomy (RMT) and full sternotomy (FS) have been conflicting. Furthermore, the synthesis of mid-term mortality has not been performed., Methods: MEDLINE and EMBASE were searched through April 2022 to identify propensity score matched (PSM) studies or randomized controlled trial (RCT) which compared outcomes following SAVR among three incisional approaches: FS, MS, or RMT. The network analysis was performed to compare these approaches with random effects model. Mid-term mortality was defined as 1-year mortality., Results: A total of 42 studies met the inclusion criteria enrolling 14,925 patients. RCT and PSM were performed in 13 and 29 studies, respectively. The operative mortality was significantly lower with MS compared to FS (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.41-0.90, p = .01, I
2 = 25.8%) or RMT (RR: 0.51, 95% CI: 0.27-0.97, p = .03, I2 = 25.8%). RMT had significantly higher risk of reoperation for bleeding compared to MS (RR: 1.65, 95% CI: 1.18-2.30, p = .003, I2 = 0%). Hospital length of stay was significantly shorter with MS compared to FS (mean difference: -0.89 days, 95% CI: -1.58 to -0.2, p = .01, I2 = 95.5%) while it was equivocal between FS and RMT. The mid-term mortality was similar among the three approaches., Conclusions: While mid-term mortality was comparable among approaches, MS may be a safe and potentially more effective approach than FS and RMT for SAVR in the short term., (© 2022 Wiley Periodicals LLC.)- Published
- 2022
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38. Outcomes of Surgical Aortic Valve Replacement After Transcatheter Aortic Valve Implantation.
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Ogami T, Ridgley J, Serna-Gallegos D, Kliner DE, Toma C, Sanon S, Brown JA, Yousef S, and Sultan I
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- Aged, Aortic Valve surgery, Humans, Risk Factors, Treatment Outcome, Aortic Valve Stenosis, Endocarditis etiology, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis Implantation adverse effects, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Few studies have reported their experience in explantation of a transcatheter heart valve. We found 2,100 patients who underwent transcatheter aortic valve implantation (TAVI) from 2013 through 2021. Of 2,100, a total of 17 patients underwent surgical aortic valve replacement after TAVI, including surgical bailout. The mean age was 78.3 years. Co-morbidities were very frequent, including coronary artery disease (70.6%), atrial fibrillation (52.9%), cerebrovascular disease (47.1%), and pulmonary hypertension (41.2%). A history of cardiac surgery was observed in 6 patients (35.3%). The mean predicted risk of mortality at the time of TAVI was 7.7%. Surgical bailout was the most common indication of valve explantation (n = 8, 47.1%), followed by infective endocarditis (n = 4, 23.5%) and paravalvular leak (n = 2, 11.8%). The valve-in-valve TAVI was not feasible because of endocarditis, paravalvular leak, and history of valve-in-valve TAVI. Overall, 13 (76.5%) were performed urgently or emergently, and 10 (58.9%) required aortic root reconstruction. The mean cardiopulmonary bypass time was 158.5 minutes. In-hospital mortality was 41.2%. Transcatheter heart valve explantation continues to be rare; however, these data will continue to be informative as TAVI explantations will become more common with time., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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39. Cerebral protection using deep hypothermic circulatory arrest versus retrograde cerebral perfusion for aortic hemiarch reconstruction.
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Arnaoutakis GJ, Ogami T, Bobba CM, Serna-Gallegos D, Brown JA, Jeng EI, Martin TD, Beaver TM, Yousef S, Navid F, and Sultan I
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- Adult, Aorta, Thoracic surgery, Cerebrovascular Circulation, Circulatory Arrest, Deep Hypothermia Induced methods, Hospital Mortality, Humans, Perfusion methods, Retrospective Studies, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery
- Abstract
Background: With evolutions in technique, recent data encourage the use of cerebral perfusion during aortic arch repair. However, a randomized data have demonstrated higher rates of neurologic injury according to MRI lesions using antegrade cerebral perfusion during hemiarch reconstruction., Methods: This was a retrospective review of two institutional aortic center databases to identify adult patients who underwent aortic hemiarch reconstruction for elective aortic aneurysm or acute type A aortic dissection. Patients were stratified according to cerebral protection method: (1) deep hypothermic circulatory arrest (DHCA) group versus (2) DHCA/retrograde cerebral perfusion (RCP) group., Results: A total of 320 patients and 245 patients underwent hemiarch reconstruction for aortic aneurysm electively and aortic dissection, respectively. In aneurysmal pathology, the DHCA group included 133 patients and the DHCA/RCP group included 187 patients. Operative mortality was 0.8% in the DHCA group and 2.7% in the DHCA/RCP group (p = 0.41). Kaplan-Meier survival estimates revealed comparable 2-year survival (p = 0.14). In dissection, 43 patients and 202 patients were included in the DHCA group and the DHCA/RCP group, respectively. Operative mortality was equivalent between the two groups (11.6% in the DHCA group and 9.4% in the DHCA/RCP group, p = 0.58). Long-term survival was similar at 2 years between the groups (p = 0.06). Multivariable analysis showed cerebral perfusion strategy was not associated with the composite outcome of operative mortality and stroke., Conclusions: In treating both elective and acute ascending aortic pathologies with hemiarch reconstruction, both DHCA alone or in combination with RCP yield comparable results., (© 2022 Wiley Periodicals LLC.)
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- 2022
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40. Patient and surgeon factors contributing to bailout cholecystectomies: a single-institutional retrospective analysis.
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Yoshida MC, Ogami T, Ho K, Bui EX, Khedr S, and Chen CC
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- Cholecystectomy methods, Humans, Inflammation etiology, Leukocytosis etiology, Leukocytosis surgery, Male, Retrospective Studies, Cholecystectomy, Laparoscopic adverse effects, Cholecystectomy, Laparoscopic methods, Cholecystitis, Acute etiology, Cholecystitis, Acute surgery, Surgeons
- Abstract
Background: Laparoscopic cholecystectomies continue to pose trouble for surgeons in the face of severe inflammation. In the advent of inability to perform an adequate dissection, a "bailout cholecystectomy" is advocated. Conversion to open or subtotal cholecystectomy is among the standard bailout procedures in such instances., Methods: We performed a retrospective single institution review from January 2016 to August 2019. All patients who underwent a cholecystectomy were included, while those with a concurrent operation, malignancy, planned as an open cholecystectomy, or performed by a low volume surgeon were excluded. Patient characteristics, operative reports, and outcomes were collected, as were surgeon characteristics such as years of experience, case volume, and bailout rate. Univariable and multivariable analysis were performed., Results: 2458 (92.6%) underwent laparoscopic total cholecystectomy (LTC) and 196 (7.4%) underwent a bailout cholecystectomy (BOC). BOC patients tended to be older (p < 0.001), male (p < 0.001), have a longer duration of symptoms (p < 0.001), and higher ASA class (p < 0.001). They also had more signs of biliary inflammation, as evidenced by increased leukocytosis (p < 0.001), tachycardia (p < 0.001), bilirubinemia (p = 0.003), common bile duct dilation (p < 0.001), and gallbladder wall thickening (p < 0.001). The BOC cohort also had increased rates of complications, including bile leak (16%, p < 0.001), retained stone (5.1%, p = 0.005), operative time (114 min vs 79 min, p < 0.001), and secondary interventions (22.7%, p < 0.001). Male gender (aOR = 2.8, p < 0.001), preoperative diagnosis of acute cholecystitis (aOR = 2.2, p = 0.032), right upper quadrant tenderness (aOR = 3.0, p = 0.008), Asian race (aOR = 2.7, p = 0.014), and intraoperative adhesions (aOR = 13.0, p < 0.001) were found to carry independent risk for BOC. Surgeon bailout rate ≥ 7% was also found to be an independent risk factor for conversion to BOC., Conclusions: Male gender, signs of biliary inflammation (tachycardia, leukocytosis, dilated CBD, and diagnosis of acute cholecystitis), as well as surgeon bailout rate of 7% were independent risk factors for BOC., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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41. Technical aspects of robotically assisted left atrial myxoma resection.
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Deitz RL, Ogami T, Ashraf SF, Kaczorowski DJ, and Bonatti J
- Abstract
Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
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- 2022
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42. Misdiagnosis of Thoracic Aortic Emergencies Occurs Frequently Among Transfers to Aortic Referral Centers: An Analysis of Over 3700 Patients.
- Author
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Arnaoutakis GJ, Ogami T, Aranda-Michel E, Dai Y, Holmes R, Beaver TM, Serna-Gallegos D, Martin TD, Navid F, Yousef S, and Sultan I
- Subjects
- Acute Disease, Diagnostic Errors, Emergencies, Female, Hematoma diagnosis, Humans, Male, Middle Aged, Referral and Consultation, Retrospective Studies, Aortic Dissection diagnosis, Aortic Dissection surgery, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic surgery, Aortic Diseases diagnostic imaging
- Abstract
Background Acute aortic syndromes may be prone to misdiagnosis by nonreferral aortic centers with less diagnostic experience. We evaluated regional variability in these misdiagnosis trends among patients transferred to different regional quaternary care centers with presumed acute aortic syndromes. Methods and Results Two institutional aortic center databases were retrospectively reviewed for emergency transfers in patients diagnosed with acute aortic dissection, intramural hematoma, penetrating aortic ulcer, thoracic aortic aneurysm, or aortic pseudoaneurysm between 2008 and 2020. Transferring diagnoses versus actual diagnoses were reviewed using physician notes and radiology reports. Misdiagnoses were confirmed by a board-certified cardiothoracic surgeon. A total of 3772 inpatient transfers were identified, of which 1762 patients were classified as emergency transfers. The mean age was 64 years (58% male). Patients were transferred from 203 medical centers by ground (51%) or air (49%). Differences in transfer diagnosis and actual diagnosis were identified in 188 (10.7%) patients. Of those, incorrect classification of Type A versus B dissections was identified among 23%, and 30% of patients with a referring diagnosis of an acute aortic dissection did not have one. In addition, 14% transferred for contained/impending rupture did not have signs of rupture. All misdiagnoses were secondary to misinterpretation of imaging, with motion artifacts (n=32, 17%) and postsurgical changes (n=44, 23%) being common sources of diagnostic error. Conclusions Misdiagnosis of acute aortic syndromes commonly occurred in patients transferred to 2 separate large aortic referral centers. Although diagnostic accuracy may be improving, there are opportunities for improved physician awareness through standardized web-based imaging education.
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- 2022
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43. MAB21L4 regulates the TGF-β-induced expression of target genes in epidermal keratinocytes.
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Ogami T, Tamura Y, Toss K, Yuki K, Morikawa M, Tsutsumi S, Aburatani H, Miyazawa K, Miyazono K, and Koinuma D
- Subjects
- Humans, Keratinocytes metabolism, Male, Promoter Regions, Genetic, RNA, Small Interfering genetics, Smad3 Protein genetics, Smad3 Protein metabolism, Intracellular Signaling Peptides and Proteins metabolism, Signal Transduction, Transforming Growth Factor beta metabolism, Transforming Growth Factor beta pharmacology
- Abstract
Smad proteins transduce signals downstream of transforming growth factor-β (TGF-β) and are one of the factors that regulate the expression of genes related to diseases affecting the skin. In the present study, we identified MAB21L4, also known as male abnormal 21 like 4 or C2orf54, as the most up-regulated targets of TGF-β and Smad3 in differentiated human progenitor epidermal keratinocytes using chromatin immunoprecipitation sequencing (ChIP-seq) and RNA sequencing (RNA-seq). We found that TGF-β induced expression of the barrier protein involucrin (encoded by the IVL gene). Transcriptional activity of the IVL promoter induced by TGF-β was inhibited by MAB21L4 siRNAs. Further analysis revealed that MAB21L4 siRNAs also down-regulated the expression of several target genes of TGF-β. MAB21L4 protein was located mainly in the cytosol, where it was physically bound to Smad3 and a transcriptional corepressor c-Ski. siRNAs for MAB21L4 did not inhibit the binding of Smad3 to their target genomic regions but down-regulated the acetylation of histone H3 lys 27 (H3K27ac), an active histone mark, near the Smad3 binding regions. These findings suggest that TGF-β-induced MAB21L4 up-regulates the gene expression induced by TGF-β, possibly through the inhibition of c-Ski via physical interaction in the cytosol., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Japanese Biochemical Society.)
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- 2022
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44. Three-year survival of transcatheter versus surgical aortic valve replacement in dialysis.
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Ogami T, Kurlansky P, Takayama H, Ning Y, Zimmermann E, Zhu RC, Ali ZA, Nazif TM, Vahl TP, Avgerinos DV, Smith CR, Leon MB, Kodali SK, and George I
- Subjects
- Aged, Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Renal Dialysis adverse effects, Risk Factors, Treatment Outcome, United States epidemiology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis etiology, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation adverse effects, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
To highlight the trends of surgical (open) aortic valve replacement (SAVR) as well as to compare the outcome between transcatheter aortic valve replacement (TAVR) and SAVR in elderly dialysis patients. TAVR has evolved as an effective alternative to surgery (SAVR) for aortic stenosis. We identified dialysis-dependent patients who underwent SAVR or TAVR from 2000 to 2015 from the United States Renal Data System using ICD-9 codes. We defined high-risk surgical patients as age over 70 or older. The primary endpoint was survival at 3 years and we compared the outcome between SAVR and TAVR groups using inverse probability of treatment weighting (IPTW). A total of 4332 and 1280 dialysis patients underwent SAVR and TAVR, respectively, during the study period. Among SAVR cohort, 3312 patients underwent SAVR before June 2012 and 1020 after June 2012. In-hospital mortality was significantly worse before 2012 (14.6% vs. 11.3% after 2012, p = 0.007) as well as estimated 3-year mortality (69.1% vs. 60.3% after 2012, p < 0.001). After June 2012, the TAVR cohort was older and had more comorbidities including coronary artery disease and congestive heart failure compared to the SAVR cohort. After IPTW, in-hospital mortality was significantly lower after TAVR versus SAVR (odds ratio 0.38 [95% confidence interval [CI], 0.27-0.52], p < 0.001). However, TAVR had a significantly higher risk of 3-year mortality than SAVR (hazard ratio 1.24 [95% CI 1.1-1.39], p < 0.001). TAVR may be a reasonable and potentially preferable alternative to SAVR in the elderly dialysis population in the short-term period., (© 2022 Wiley Periodicals LLC.)
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- 2022
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45. Commentary: Infective endocarditis of the aortic valve: External influences?
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Ogami T and Sultan I
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- 2022
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46. Paravalvular leak after heart valve replacement: Transcatheter or surgical management?
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Ogami T, Sanon S, and Sultan I
- Subjects
- Cardiac Catheterization, Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Prosthesis Failure, Treatment Outcome, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis Implantation adverse effects, Mitral Valve Insufficiency surgery
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- 2022
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47. Influence of Dry Eye Disease on the Measurement Repeatability of Corneal Curvature Radius and Axial Length in Patients with Cataract.
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Hiraoka T, Asano H, Ogami T, Nakano S, Okamoto Y, Yamada Y, and Oshika T
- Abstract
The influence of dry eye disease (DED) on ocular biometric measurements is unclear. We aimed to investigate the effect of DED on the repeatability of ocular biometric measurements in cataract patients. Overall, 114 eyes scheduled for cataract surgery were enrolled. Before surgery, DED parameters including tear film break-up time (BUT), corneal and conjunctival staining scores, and subjective symptoms were examined. Corneal curvature radius and axial length were assessed twice on the same day using IOLMaster-500 (Carl Zeiss Meditec), and the absolute difference between the two measurements was calculated and used as an index of measurement repeatability. The measurement repeatability of the steep meridian of corneal curvature radius was significantly worse in eyes with DED than in those without DED ( p = 0.044) and was significantly associated with BUT (r = -0.206, p = 0.031). The measurement repeatability of axial length was negatively correlated with BUT (r = -0.199, p = 0.041) and positively correlated with the corneal staining score (r = 0.253, p = 0.009). In conclusion, the measurement repeatability of corneal curvature radius declined in eyes with DED. Shortened BUTs were associated with a deterioration in the measurement repeatability of corneal curvature radius and axial length.
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- 2022
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48. The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center: A Retrospective Cohort Analysis.
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Powers BD, Fulp W, Dhahri A, DePeralta DK, Ogami T, Rothermel L, Permuth JB, Vadaparampil ST, Kim JK, Pimiento J, Hodul PJ, Malafa MP, Anaya DA, and Fleming JB
- Subjects
- Adenocarcinoma mortality, Cancer Care Facilities statistics & numerical data, Chemoradiotherapy, Adjuvant, Chemotherapy, Adjuvant, Facilities and Services Utilization, Female, Humans, Male, Pancreatectomy adverse effects, Pancreatic Neoplasms mortality, Postoperative Complications, Residence Characteristics, Retrospective Studies, Survival Rate, United States epidemiology, Adenocarcinoma surgery, Critical Pathways, Pancreatic Neoplasms surgery, Socioeconomic Factors
- Abstract
Objective: To assess the impact of a granular measure of SED on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway., Summary of Background Data: Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for PDAC. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables., Methods: We conducted a retrospective cohort study of 1552 PDAC patients between 2008 and 2015. Patients were stratified using the area deprivation index, a validated dataset that ranks census block groups based on SED. Multivariable models were used in the curative surgery cohort to predict the impact of SED on (1) grade 3/4 Clavien-Dindo complications, (2) initiation of adjuvant therapy, (3) completion of adjuvant therapy, and (4) overall survival., Results: Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival., Conclusions: Although nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer., Competing Interests: The authors report no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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49. The Effect of Diquafosol Ophthalmic Solution on Clinical Parameters and Visual Function in Soft Contact Lens-Related Dry Eye.
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Ogami T, Asano H, Hiraoka T, Yamada Y, and Oshika T
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- Cornea, Humans, Lubricant Eye Drops, Ophthalmic Solutions, Polyphosphates, Tears, Uracil Nucleotides, Contact Lenses, Hydrophilic, Dry Eye Syndromes drug therapy, Dry Eye Syndromes etiology
- Abstract
Introduction: This study evaluated the efficacy and safety of diquafosol ophthalmic solution (DQS) in soft contact lens (SCL)-related dry eye using artificial tear as a control., Methods: This study enrolled 26 patients with SCL-related dry eye. DQS and artificial tears (AT) were instilled into the right and left eyes, respectively, with their SCLs on. Dry eye examinations (including tear film breakup time, tear volume, and staining score) were performed and visual function (including contrast sensitivity) was also evaluated before (at baseline) and after treatment (at 4- and 8-week examinations). Subjective symptoms were assessed separately in each eye using a questionnaire on dry eye in contact lens wearers. The results were compared before and after treatment, and between the right eyes treated with DQS (the DQS eye) and the left eyes treated with AT (the AT eye) using the mixed effect model., Results: Corneal and conjunctival staining scores at 8-week examination were significantly lower than those at baseline in the DQS eye (p = 0.03; p < 0.001, respectively), but no significant changes were observed in the AT eye. Most subjective symptoms improved significantly in both the DQS and AT eyes. However, major subjective symptoms (dryness and blurry vision) improved significantly only in the DQS eye at 8-week examination. Contrast sensitivity at 8-week examination in the DQS eye improved significantly at 12 cycles/degree compared to baseline (p = 0.001) and was significantly better than that in the AT eye (p = 0.03). There were no adverse events related to DQS or AT., Conclusions: DQS was effective and safe for SCL-related dry eye. DQS also improved contrast sensitivity., Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Identification No. UMIN000024064., (© 2021. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)
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- 2021
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50. A Standardized Approach Improves Outcomes of Extracorporeal Membrane Oxygenation for Postcardiotomy Shock.
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Ogami T, Takayama H, Melehy A, Witer L, Kaku Y, Fried J, Masoumi A, Brodie D, and Takeda K
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- Hospital Mortality, Humans, Retrospective Studies, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Cardiac Surgical Procedures adverse effects, Extracorporeal Membrane Oxygenation adverse effects, Shock
- Abstract
Postcardiotomy shock (PCS) has historically been associated with substantial morbidity and mortality. Mortality at discharge is reportedly more than 60%. We investigated the outcomes of our standardized approach to veno-arterial extracorporeal membrane oxygenation (ECMO) management for PCS. We retrospectively reviewed 60 consecutive PCS patients who required ECMO following major cardiac surgery from January 2017 to September 2019. Index surgery included CABG (n = 10), valve (n = 23), valve and CABG (n = 12), root surgery (n = 10), and other (n = 5). Median lactate level, systolic blood pressure, and mean pulmonary artery pressure before ECMO were 4.0 mmol/L, 80 mm Hg, and 29 mm Hg, respectively. Fifty-nine patients (98%) were on two vasopressors, and 54 (90%) were on at least two inotropes. Vasoactive-Inotropic Score was 30 (IQR, 25-49). Eighty percent of patients received peripheral ECMO. Median ECMO flow index was 1.61 (IQR, 1.4-2.0) L/min/m2. Anticoagulation was not given in 12 (20%) patients during ECMO support. Major adverse events included chest re-exploration (15%), stroke (6.7%), renal replacement therapy (22%), and limb ischemia (5%). In-hospital mortality was 33%. This study suggests that a standardized approach with a dedicated ECMO team is feasible and may improve outcomes of PCS., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2021.)
- Published
- 2021
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