These articles were selected from 130 published by our staff in 2006. To view the complete listing, go to the Staff Directory and search on individual surgeon names.

Valvular Heart Disease

Mihaljevic T, Blackstone EH, Lytle BW. Folding valvuloplasty without leaflet resection: Simplified method for mitral valve repair. Annals of Thoracic Surgery 2006 Dec;82(6):e46-e48. We describe a new surgical technique for treatment of valvular heart disease in which the mitral valve repair was accomplished by simply folding the prolapsed segment of the posterior leaflet and inserting a flexible annuloplasty ring.

Roselli EE, Smedira NG, Blackstone EH. Failure modes of the Carpentier-Edwards pericardial  bioprosthesis in the aortic position. Journal of Heart Valve Disease 2006 May;15(3):421-427.   Perimount bioprostheses rarely fail from design-related causes; rather, they fail at almost equal  rates from calcific and non-calcific degeneration, both of which occur late and are age  dependent. Further investigation into improved methods for fixation and anti-calcification in  preparing these valves is warranted.

Smedira NG, Blackstone EH, Roselli EE, Laffey CC, Cosgrove DM. Are allografts the biologic  valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation  for structural valve deterioration of allograft and pericardial prostheses. Journal of Thoracic and  Cardiovascular Surgery 2006 Mar;131(3):558-564.     In adults across multiple age strata, risk of reoperation for structural valve deterioration after  aortic valve replacement was similar for stented bovine pericardial prostheses and allograft  valves. This suggests that pericardial valves may be appropriate for nonelderly persons.

Ischemic Heart Disease

Brener SJ, Lytle BW, Casserly IP, Ellis SG, Topol EJ, Lauer MS. Predictors of revascularization method and longterm outcome of  percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous  coronary bypass surgery. European Heart Journal 2006 Feb;27(4):413-418.   Choice of revascularization method in patients with  previous CABG is dictated mostly by anatomic considerations and less by clinical characteristics. In contrast, clinical characteristics  predominantly affect long-term outcome, but method of revascularization has a limited effect.

Deglurkar I, Mal N, Mills WR, Popovic ZB, McCarthy P, Blackstone EH, Laurita KR, Penn MS. Mechanical and electrical effects of cell- based gene therapy for ischemic cardiomyopathy are independent. Human Gene Therapy 2006 Nov;17(11):1144-1151.   Transient  reestablishment of stem cell homing via transplantation of modified SKMBs is sufficient to improve cardiac function. However, risk of  ventricular tachycardia increased.

Sabik JF, III, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW. Influence of patient characteristics and arterial grafts on  freedom from coronary reoperation. Journal of Thoracic and Cardiovascular Surgery 2006 Jan;131(1):90-98.  Arteriosclerosis risk  factors increased the likelihood of reoperation, and patient comorbidity and arterial grafting decreased it. Aggressive risk-factor  reduction and arterial revascularization should result in fewer coronary reoperations.

Cardiopulmonary Support

Smedira NG, Dyke CM, Koster A, Jurmann M, Bhatia DS, Hu T, McCarthy HL, II, Lincoff AM, Spiess BD, Aronson S. Anticoagulation with bivalirudin for off-pump  coronary artery bypass grafting: The results of the EVOLUTION-OFF study.  Journal of Thoracic and Cardiovascular Surgery 2006 Mar;131(3):686-692.  Bivalirudin, used as an anticoagulant in patients undergoing off-pump CABG, has a safety profile similar to that of heparin with protamine reversal.

Heart Failure

Gonzalez-Stawinski GV, Davis RD, Jr. Rituximab as monotherapy for elicited  xenoreactive antibody responses. Journal of Heart and Lung Transplantation 2006  Dec;25(12):1462-1466.  In a non-human primate model of xenotransplantation,  anti-Galalpha-1-3 Gal antibody responses were elicited despite the elimination of B cells by rituximab. These responses seem to be mediated in part by cells lacking common B-cell surface antigens.

Schenk S, McCarthy PM, Blackstone EH, Feng J, Starling RC, Navia JL, Zhou L,  Hoercher KJ, Smedira NG, Fukamachi K. Duration of inotropic support after left  ventricular assist device implantation: Risk factors and impact on outcome. Journal of Thoracic and Cardiovascular Surgery 2006 Feb;131(2):447-454.   Longer  inotropic support after left ventricular assist device support, a surrogate for right  ventricular dysfunction, is associated with increased mortality before  transplantation. Pre-transplantation right ventricular stroke work index is strongly associated with inotropic support duration and might be useful in decision-making  for biventricular support, destination therapy, or total artificial heart.

Atrial Fibrillation

Gillinov AM, Bhavani S, Blackstone EH, Rajeswaran J, Svensson LG, Navia JL, Pettersson BG, Sabik JF, III, Smedira NG, Mihaljevic T, McCarthy PM, Shewchik J, Natale A. Surgery for permanent atrial fibrillation: Impact of patient factors and lesion set. Annals of Thoracic Surgery 2006 Aug;82(2):502-514.   In cardiac surgical patients with permanent atrial fibrillation, the left atrial lesion set should include  wide pulmonary vein isolation, at least one connection between right and left pulmonary veins, and a connection to the mitral annulus.  Availability of alternative energy sources has virtually eliminated need for the cut-and-sew Cox-maze procedure.

Thoracic Aorta Disease

Greenberg RK, West K, Pfaff K, Foster J, Skender D, Haulon S, Sereika J, Geiger L, Lyden SP, Clair D, Svensson L, Lytle B. Beyond the aortic bifurcation: Branched endovascular grafts for thoracoabdominal and aortoiliac aneurysms. Journal of Vascular Surgery 2006 May;43(5):879-886. Branch vessel technology has made it technically feasible to preserve critical end-organ perfusion in the setting of  complex thoracoabdominal, suprarenal, and common iliac aneurysms. The relatively low acute mortality rate and lack of short-term  branch vessel loss are encouraging.

Greenberg RK, Svensson LG. Hybrid thoracic aneurysm repair. Endovascular Today 2006 Feb;5(2):67-72. Important improvements have been made to the hybrid approach for complex proximal aortic aneurysm repair. Elimination of a thoracotomy, aortic clamping, and  extensive exposure will likely render better results and allow a therapeutic option to patients who have historically been relegated to  medical management.

Kouchoukos NT, Bavaria JE, Coselli JS, De la Torre R, Ikonomidis JS, Karmy-Jones RC, Mitchell RS, Shemin RJ, Spielvogel D, Svensson LG, Wheatley GH. Guidelines for credentialing of practitioners to perform endovascular stent-grafting of the thoracic aorta. Journal of Thoracic and Cardiovascular Surgery 2006 Mar;131(3):530-532.   Cardiothoracic surgeons are encouraged to obtain all of the necessary skills and knowledge to successfully perform endovascular procedures independently, but may elect to participate as part of a team. By combining expertise of physicians of different disciplines, patient safety and the quality of care delivered will be enhanced.

Salemi A, Pettersson GB. Aortic arch reconstruction utilizing a simple reversed graft trimming technique. Interactive Cardiovascular and Thoracic Surgery 2006;5(3):247-248. We describe a simple method for ascending aorta and hemiarch/arch reconstruction that reduces tension, avoids graft kinking, and provides optimal orientation for the proximal anastomosis.

Pulmonary Disease

Mason DP, Quader MA, Blackstone EH, Rajeswaran J, DeCamp MM, Murthy SC, Quader AK, Rice TW. Thromboembolism after pneumonectomy for malignancy: an independent marker of poor outcome. Journal of Thoracic and Cardiovascular Surgery 2006  Mar;131(3):711-718.   Venous thromboembolism is surprisingly common (7.4% prevalence) after pneumonectomy for malignancy. Its  incidence peaked at 7 days, with most patients having been discharged and prophylaxis discontinued, and it portended poor long-term  survival. Improved screening and better prophylaxis might prevent this complication and enhance outcomes.

Murthy SC, Okereke I, Mason DP, Rice TW. A simple solution for complicated pleural effusions. Journal of Thoracic Oncology 2006 Sep;1(7):697-700.   PleurX catheters are safe, effective, and durable solutions for complicated pleural effusions and seem to provide an  attractive alternative for patients who have few other palliative options.

Pulmonary Transplant

Gaca JG, Appel JZ, III, Lukes JG, Gonzalez-Stawinski GV, Lesher A, Palestrant D, Logan JS, Love SD, Holzknecht ZE, Platt JL, Parker W, Davis RD. Effect of an anti-C5a monoclonal antibody indicates a prominent role for anaphylatoxin in pulmonary xenograft dysfunction.  Transplantation 2006 Jun 27;81(12):1686-1694.  C5a exacerbates pulmonary xenograft injury and compromises recipient hemodynamic status. Blockade of such anaphylatoxins offers a promising approach for future investigations aimed at preventing pulmonary xenograft injury.

Mason DP, Boffa DJ, Murthy SC, Gildea TR, Budev MM, Mehta AC, McNeill AM, Smedira NG, Feng J, Rice TW, Blackstone EH, Pettersson
BG. Extended use of extracorporeal membrane oxygenation after lung transplantation. Journal of Thoracic and Cardiovascular Surgery
2006 Oct;132(4):954-960. Severe graft failure after lung transplantation is rare but carries a high mortality. ECMO provides lifesaving  support for a substantial proportion of these patients, but complications are common. Best results are achieved in the setting of early  graft failure or severe acute rejection, but not pneumonia or sepsis.

Major Airway Disease

Ranes JL, Budev MM, Murthy S, Mehta AC. Management of tracheomediastinal fistulas using  self-expanding metallic stents. Journal of Thoracic and Cardiovascular Surgery 2006  Mar;131(3):748-749.  SEMS, by promoting formation of granulation tissue, are efficacious in  treating complex airway fistulas.

Esophageal Disease

Rice TW, Khuntia D, Rybicki LA, Adelstein DJ, Vogelbaum MA, Mason DP, Murthy SC, Blackstone EH. Brain metastases from esophageal cancer: A phenomenon of adjuvant  therapy? Annals of Thoracic Surgery 2006 Dec;82(6):2042-2049.   A dose-related increased  incidence of brain metastases after adjuvant therapy for esophageal cancer cannot be  explained by increased longevity. Adjuvant therapy itself, not just advanced disease, appears to  create conditions conducive to developing these rapidly fatal metastases.

Innovation

Kamohara K, Fukamachi K, Ootaki Y, Akiyama M, Cingoz F, Ootaki C, Vince DG, Popovic ZB,  Kopcak MW, Jr., Dessoffy R, Liu J, Gillinov AM. Evaluation of a novel device for left atrial  appendage exclusion: The second-generation atrial exclusion device. Journal of Thoracic and  Cardiovascular Surgery 2006 Aug;132(2):340-346.    A second-generation left atrial exclusion device enabled rapid, reliable, and safe epicardial LAA exclusion in a canine model.

Quality / Guidelines / Prevention of Complications

Banbury MK, Brizzio ME, Rajeswaran J, Lytle BW, Blackstone EH. Transfusion increases the  risk of postoperative infection after cardiovascular surgery. Journal of the American College of  Surgeons 2006 Jan;202(1):131-138.   Blood products tended to be used in the sickest patients. But after accounting for this, risk of infection increased incrementally with each unit of blood  transfused. No amount of blood loss treated by transfusion is innocuous.

Bhudia SK, Cosgrove DM, Naugle RI, Rajeswaran J, Lam BK, Walton E, Petrich J, Palumbo  RC, Gillinov AM, Apperson-Hansen C, Blackstone EH. Magnesium as a neuroprotectant in  cardiac surgery: A randomized clinical trial. Journal of Thoracic and Cardiovascular Surgery  2006 Apr;131(4):853-861.  A randomized, blinded, placebo-controlled clinical trial of increasing serum magnesium during cardiopulmonary bypass and for 24 hours thereafter demonstrated  that it was safe and offered short-term neurologic benefits, particularly in preserving short-term  memory and preventing reemergence of primitive reflexes.

Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Jr., Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS.  ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report  of the American College of Cardiology/American Heart Association Task Force on Practice  Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular  Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Journal of the American College of Cardiology 2006 Aug 1;48(3):e1-148.

Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK,  Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jr., Jacobs AK, Adams  CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guideline update on perioperative  cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to update the 2002 guidelines on  perioperative cardiovascular evaluation for noncardiac surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular  Angiography and Interventions, and Society for Vascular Medicine and Biology. Journal of the  American College of Cardiology 2006 Jun 6;47(11):2343-2355.

General

Blackstone EH. Thinking beyond the risk factors. European Journal of Cardio-Thoracic Surgery 2006 May;29(5):645-652. Thinking beyond risk factors to their neutralization by research,  innovation, and application of knowledge can be as spectacularly successful as was fleeing foul   air in halting Black Death.

Svensson LG. Device discordancy: Lost cords, quick-fix seekers, quality, and ethics. Journal of  Thoracic and Cardiovascular Surgery 2006 Feb;131(2):261-263. Every surgeon accustomed to 1% mortality and 1% stroke prevalence for CABG or valve surgery with excellent long-term outcome of patients will have to confront ethical dilemmas and the issues involved with survival  of cardiovascular and vascular surgery. The high risk of stroke with transcatheter devices will also need to be lowered.