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1.
J Trauma Acute Care Surg ; 89(5): 849-860, 2020 11.
Article in English | MEDLINE | ID: mdl-32852356

ABSTRACT

This article is a synopsis of a book created for the 50th anniversary meeting of the Western Trauma Association in February 2020. On the occasion of the 50th Anniversary of the Western Trauma Association, a review of the organization's history, its contribution to trauma care and the development of leaders in the field, and its enduring unique culture reveals a vibrant association grounded in the values of its founders and well-positioned to continue successfully into the next 50 years.


Subject(s)
Leadership , Societies, Medical/history , Traumatology/history , Wounds and Injuries/therapy , Anniversaries and Special Events , Friends , History, 20th Century , History, 21st Century , Humans , Interpersonal Relations/history , Male , Societies, Medical/organization & administration , Traumatology/organization & administration , United States
2.
J Interv Cardiol ; 25(6): 557-64, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22861054

ABSTRACT

Hybrid coronary revascularization, which involves minimally invasive direct coronary artery bypass surgery using the left internal mammary artery to left anterior descending and percutaneous coronary intervention using drug-eluting stents for the remaining diseased coronary vessels, is an innovative approach to decrease the morbidity of conventional surgery. Little information is available to guide hospital managers and physician leaders in implementing a hybrid revascularization program. In this article, we describe the people-process-technology issues that managers and leaders are likely to encounter as they develop a hybrid revascularization program in their practice.


Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/therapy , Drug-Eluting Stents , Percutaneous Coronary Intervention , Cooperative Behavior , Humans , Mammary Arteries/transplantation , Operating Rooms/organization & administration , Patient Care Team , Patient Selection
3.
Echocardiography ; 26(8): 973-6, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19968685

ABSTRACT

We report the case of an enormous right atrial hemangioma in an asymptomatic 42-year-old woman. The diagnosis was made by echocardiogram after the patient was found to have an abnormal EKG during a routine medical exam. The hemangioma is the largest described in English literature. The tumor was surgically resected and the patient did well postoperatively. In this case report, we discuss the discovery of the tumor and treatment of our patient. A brief discussion of cardiac hemangiomas follows.


Subject(s)
Heart Atria/diagnostic imaging , Heart Atria/surgery , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Hemangioma/diagnostic imaging , Hemangioma/surgery , Adult , Female , Humans , Treatment Outcome , Ultrasonography
4.
Heart Fail Clin ; 3(2): 181-210, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17643921

ABSTRACT

This article addresses the pathophysiology, the treatment options, and their rationale in the setting of life-threatening acute myocardial infarction and acute on chronic ischemia. Although biases may exist between cardiologists and surgeons, with this review, we hope to provide the reader with information that will shed light on the options that best suit the individual patient in a given set of circumstances.


Subject(s)
Cardiac Surgical Procedures/methods , Myocardial Ischemia/surgery , Salvage Therapy/methods , Angioplasty, Balloon, Coronary/methods , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Heart-Assist Devices , Humans , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Myocardial Infarction/surgery , Myocardial Ischemia/complications , Myocardial Ischemia/physiopathology , Myocardial Reperfusion/methods , Risk Factors , Shock, Cardiogenic/etiology , Shock, Cardiogenic/prevention & control , Thrombolytic Therapy/methods , Treatment Outcome
5.
Ann Thorac Surg ; 83(2): 483-9, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17257973

ABSTRACT

BACKGROUND: The incidence of coronary artery bypass graft surgery (CABG) performed in elderly patients has been increasing over recent years. We sought to evaluate clinical outcomes of octogenarians undergoing CABG using an audited state-wide mandatory database. METHODS: New York State Department of Health's Cardiac Reporting System was analyzed from 1998 to 2002. In all, 88,154 patients undergoing isolated CABG were identified. Patients were divided into four age groups: less than 50 years (group 1, n = 6,527), 50 to 64 years (group 2, n = 30,088), 65 to 79 years (group 3, n = 43,369), and 80 years and above (group 4, n = 8,170). RESULTS: Of all patients, 9.3% were octogenarians. In addition to marginally worse coronary artery disease, octogenarians generally manifested a higher incidence of preoperative risk factors such as cerebrovascular disease, peripheral vascular disease, and congestive heart failure compared with younger patients at baseline. Both length of hospital stay and in-hospital mortality rate were significantly higher among octogenarians. The incidence of postoperative complications was higher among octogenarians. Multivariate analysis demonstrated renal failure requiring dialysis (odds ratio [OR] = 4.4), myocardial infarction within 6 hours before surgery (OR = 3.6), chronic obstructive pulmonary disease (OR = 1.7), congestive heart failure at admission (OR = 1.7), emergent operation (OR = 1.6), Canadian Cardiovascular Society functional class IV (OR = 1.5), hypertension (OR = 1.4), and low ejection fraction (OR = 0.98) to be significant independent predictors of in-hospital mortality of octogenarians. Discharge to home rates were significantly lower for octogenarians. CONCLUSIONS: Although early outcomes in octogenarians are acceptable, these factors alone are not sufficient to reflect overall success of CABG in these patients, given the strikingly lower discharge to home rates. Attention to full functional recovery in octogenarians is essential.


Subject(s)
Coronary Artery Bypass/statistics & numerical data , Patient Discharge/statistics & numerical data , Age Distribution , Aged , Aged, 80 and over , Cardiovascular Diseases/complications , Coronary Artery Disease/complications , Coronary Artery Disease/surgery , Hospital Mortality , Humans , Incidence , Length of Stay , Middle Aged , Multivariate Analysis , New York , Postoperative Complications/epidemiology , Renal Dialysis , Renal Insufficiency/complications , Renal Insufficiency/therapy , Risk Factors , Treatment Outcome
6.
Echocardiography ; 23(6): 495-8, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16839388

ABSTRACT

Takayasu's arteritis (TA) is a granulomatous vasculitis of medium and large arteries, which most often presents as pulseless disease due to widespread arterial stenoses. Only the minority of TA patients have aortic valve insufficiency, which is due to aortic root dilatation following aortitis and aneurysm formation. No other cardiac valve is involved. We report a case of Takayasu's disease-related severe aortic insufficiency (AI) in a Filipino woman, which necessitated aortic valve replacement. It is important to consider TA in the differential diagnosis of AI in young women, particularly those with early-onset systemic hypertension and pulse deficits. Early diagnosis and therapy of TA can improve outcomes.


Subject(s)
Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Heart Valve Prosthesis Implantation , Takayasu Arteritis/complications , Adult , Aortic Valve Insufficiency/diagnostic imaging , Diagnosis, Differential , Echocardiography, Doppler, Color , Female , Humans
7.
Emerg Radiol ; 13(1): 31-3, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16807714

ABSTRACT

We report a case of a 56-year-old man with traumatic aortic rupture (TAR) sustained in a motor vehicle accident diagnosed by helical computed tomography, aortography, and transesophageal echocardiography. A large majority of patients with TAR never make it to the hospital, and for those who do, a timely diagnosis is critical for survival. We discuss the merits and pitfalls of the three imaging modalities.


Subject(s)
Aortic Rupture/diagnosis , Aortography , Echocardiography, Transesophageal , Tomography, X-Ray Computed , Accidents, Traffic , Aneurysm, False/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Contusions/diagnosis , Hemothorax/diagnosis , Humans , Lung Injury , Male , Middle Aged , Rib Fractures/diagnosis , Thoracic Surgical Procedures
8.
J Card Surg ; 21(2): 125-9, 2006.
Article in English | MEDLINE | ID: mdl-16492267

ABSTRACT

BACKGROUND AND AIM: The current shortage of donor hearts has forced the criteria of organ procurement to be extended, leading to increased use of older donor hearts to bridge the gap between demand and availability. Our objective was to analyze the effect of donor age on outcomes after cardiac transplantation. METHODS: We retrospectively studied 864 patients who underwent cardiac transplantation at New York Presbyterian Hospital - Columbia University between 1992 and 2002. Patients were divided into two groups; donor age <40 years (Group A, n = 600) and donor age > or =40 years (Group B, n = 264). RESULTS: Characteristics including gender, body mass index, and cytomegalovirus (CMV) status were significantly different between the two donor age groups. Race, CMV status, toxoplasmosis status, left ventricular assist device prior to transplant, diabetes mellitus, and retransplantation were similar in both the recipient groups, while age, gender, and BMI were different. Early mortality was lower in Group A, 5%, versus 9.5% in Group B. Multivariate analysis revealed recipient female gender (odd ratio (OR) = 1.71), retransplantation (OR = 1.63), and increased donor age (OR = 1.02) as significant predictors of poor survival in the recipient population. Actuarial survival at 1 year (86.7% vs 81%), 5 years (75% vs 65%), and 10 years (56% vs 42%) was significantly different as well with a log rank p = 0.002. CONCLUSIONS: These findings suggest that increased donor age is an independent predictor of long-term survival. However, the shortage of organs makes it difficult to follow strict guidelines when placing hearts; therefore, decisions need to be made on a relative basis.


Subject(s)
Heart Transplantation/mortality , Tissue Donors , Adult , Age Factors , Female , Follow-Up Studies , Humans , Male , Middle Aged , New York/epidemiology , Postoperative Period , Prognosis , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors
10.
Circulation ; 112(9 Suppl): I344-50, 2005 Aug 30.
Article in English | MEDLINE | ID: mdl-16159844

ABSTRACT

BACKGROUND: Patients with low ejection fraction (EF) are at a higher risk for postoperative complications and mortality. Our objective was to assess the effect of low EF on clinical outcomes after coronary artery bypass grafting (CABG). METHODS AND RESULTS: We analyzed 55,515 patients from New York State database who underwent CABG between 1997 and 1999. Patients were stratified into 1 of the 4 EF groups: Group I (EF< or =20%), Group II (EF 21% to 30%), Group III (EF 31% to 40%), and Group IV (EF>40%). History of previous myocardial infarction, renal failure, and congestive heart failure were higher in patients with low EF (all P<0.001). Group I experienced a higher incidence of postoperative respiratory failure (10.1% versus 2.9%), renal failure (2.5% versus 0.6%), and sepsis (2.5% versus 0.6%) compared with Group IV. In-hospital mortality was significantly higher in Group I (6.5% versus 1.4%; P<0.001). Multivariate analysis showed hepatic failure [odds ratio (OR), 11.2], renal failure (OR, 4.1), previous myocardial infarction (OR, 3.4), reoperation (OR, 3.4), emergent procedures (OR, 3.2), female gender (OR, 1.7), congestive heart failure (OR, 1.6), and age (OR, 1.04) as independent predictors of in-hospital mortality in the low EF group. The discharges to home rate were significantly lower in Group I versus Group IV (73.1% and 87.7%, respectively; P<0.001). CONCLUSIONS: Patients with low EF are sicker at baseline and have >4 times higher mortality than patients with high EF. However, outcomes are improving over time and are superior to historical data. Therefore, CABG remains a viable option in selected patients with low EF.


Subject(s)
Cardiac Output, Low/complications , Coronary Artery Bypass , Coronary Disease/surgery , Stroke Volume , Aged , Comorbidity , Coronary Disease/complications , Databases, Factual , Female , Heart Failure/epidemiology , Hospital Mortality , Humans , Liver Failure/epidemiology , Liver Failure/etiology , Male , Middle Aged , Myocardial Infarction/epidemiology , New York/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/etiology , Retrospective Studies , Sepsis/epidemiology , Sepsis/etiology , Severity of Illness Index , Treatment Outcome
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