Epidemiology of Stroke After Cardiac Surgery in the Current Era
Ani C. Anyanwu, Farzan Filsoufi, Sacha P. Salzberg, David J. Bronster, David H. Adams
The Journal of Thoracic and Cardiovascular Surgery; Volume 134, Issue 5, November 2007, Pages 1121-1127
Previous studies of the epidemiology of stroke in patients undergoing cardiac surgery have been based primarily on patients having coronary bypass surgery and therefore have limited applicability to the more heterogenous populations seen in the current era. We have demonstrated a relatively low incidence of stroke in a diverse contemporary cardiac surgical cohort. By enabling preoperative identification of patients at risk, our logistic model has the potential to improve preoperative patient counseling and selection and could help to define high-risk cohorts for research into stroke prevention.
Off-Pump Implant of the Jarvik 2000 Ventricular Assist Device Through Median Sternotomy
Ani C. Anyanwu, Gregory W. Fischer, Irina Plotkina, PA-C, Sean Pinney, David H. Adams
The Annals of Thoracic Surgery; Volume 84, Issue 4, October 2007, Pages 1405-1407
Implantation of a left ventricular assist device through a median sternotomy usually requires cardiopulmonary bypass. However, the biological response to cardiopulmonary bypass is sometimes deleterious in end-stage heart failure patients, as it may compound pre-existing coagulopathy or multiorgan dysfunction. Therefore, there are potential advantages to avoiding cardiopulmonary bypass during left ventricular assist device placement. We describe a technique for off-pump implantation of the Jarvik 2000 left ventricular assist device (Jarvik Heart Inc, New York, NY) through a median sternotomy.
Diabetes Is Not a Risk Factor for Hospital Mortality Following Contemporary Coronary Artery Bypass Grafting
Farzan Filsoufi, Parwis B. Rahmanian, Javier G. Castillo, Jeffrey I. Mechanick, Samin K. Sharma, David H. Adams
Interactive CardioVascular and Thoracic Surgery; Published online; September 27, 2007
The outcome of coronary artery bypass grafting (CABG) in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing contemporary CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. We retrospectively analyzed prospectively collected data of 2725 CABG patients from 01/1998-12/2005. ... Excellent results following contemporary CABG can be expected in diabetics with a similar mortality compared to non-diabetics. Therefore, our data suggest that diabetes may, in fact, not be a risk factor for adverse outcome following CABG. However, long-term survival in diabetics remains significantly inferior compared to non-diabetics.
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Excellent Results of Contemporary Coronary Artery Bypass Grafting With Systematic Application of Modern Perioperative Strategies
Farzan Filsoufi, Parwis B. Rahmanian, Javier G. Castillo, Joanna Chikwe, David H. Adams
The Heart Surgery Forum; Volume 10, Number 5, October 2007, Pages E349 - E356
Despite a worsening case mix, contemporary CABG can be performed with excellent results (operative mortality < 1%). Off-pump CABG performed in very high-risk patients obtains results similar to those of the general CABG population. Diabetes and ejection fraction were not independent predictors of early outcome. In our experience, these excellent outcomes were achieved by adopting an operative approach using modern perioperative management (epi-aortic scanning, intensive insulin therapy) and surgical techniques (off-pump CABG) based on individual patients.
Video-Assisted Trans-Mitral Left Ventricular False Aneurysm Repair With a Septal Occluder
Parwis B. Rahmanian, Farzan Filsoufi, Javier G. Castillo, David H. Adams
European Journal of Cardio-Thoracic Surgery; Volume 32, Issue 5, November 2007, Page 799
A 41-year-old male with a history of myocardial stab-wound, which was repaired with a patch through a sternotomy 25 years ago, presented with a large calcified false aneurysm at the left ventricular antero-lateral free wall (Fig. 1). He underwent a video-assisted trans-mitral false aneurysm repair using a septal occluder (Fig. 2).
Excellent Results of Cardiac Surgery in Patients With Previous Liver Transplantation
Farzan Filsoufi, Parwis B. Rahmanian, Javier G. Castillo, Eva Karlof, Thomas D. Schiano, David H. Adams
Liver Transplantation;Volume 13, Issue 9, September 2007, Pages 1317-1323
Cardiovascular diseases requiring surgical therapy in patients with prior liver transplantation are rare. Little is known about the outcome of patients with liver allograft undergoing cardiac surgery. Herein we report our experience in this patient population with an emphasis on operative outcomes and mid-term survival. ... Cardiac surgery can be performed safely in liver transplant recipients with extremely low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient, with early functional recovery. Five-year survival of liver recipients undergoing cardiac procedures is similar to that of the general population undergoing cardiac surgery. Our data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients
Results and Predictors of Early and Late Outcome of Coronary Artery Bypass Grafting in Patients with Severely Depressed Left Ventricular Function
Farzan Filsoufi, Parwis B. Rahmanian, Javier G. Castillo, Joanna Chikwe, Annapoorna S. Kini, David H. Adams
The Annals of Thoracic Surgery; Volume 84, Issue 3, September 2007, Pages 808-816
Coronary artery bypass grafting (CABG) is a well-accepted therapeutic approach in patients with symptomatic multivessel coronary artery disease and severely depressed left ventricular function. However, the potential impact of off-pump CABG in this group of patients remains unknown. In addition, there are only scarce data regarding long-term survival and its predictors in this patient population. ... Excellent results after CABG can be expected in patients with EF of 0.30 or less, with minimal increase in mortality and acceptable postoperative morbidity. Long-term survival remains limited, but recent results are substantially better than historical reports. Careful preoperative patient selection and perioperative management are essential in these patients undergoing CABG.
Cardiac Myxoma: Preoperative Diagnosis Using a Multimodal Imaging Approach and Surgical Outcome in a Large Contemporary Series
Parwis B. Rahmanian, Javier G. Castillo, Javier Sanz, David H. Adams, Farzan Filsoufi
Interactive CardioVascular and Thoracic Surgery; Volume 6, Issue 4, August 2007, Pages 479-483
Diagnosis of cardiac myxoma is typically suggested in the presence of symptoms and echocardiographic findings of an intracardiac mass and confirmed histologically. Coronary angiography (CA) and cardiac magnetic-resonance-imaging (MRI) may provide specific additional information which could lead to a precise preoperative diagnosis. ... In patients with a cardiac mass, echocardiography remains the first diagnostic imaging modality but does not allow definite discrimination between cardiac tumors and thrombi. CA shows neovascularization in 50% and has, therefore, a low sensitivity and specificity in distinguishing the nature of the mass. MRI shows specific tissue characteristics facilitating the diagnosis of myxoma preoperatively. Surgery should be performed promptly and this can provide excellent early and mid-term results.
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Predictors and Outcome of Gastrointestinal Complications in Patients Undergoing Cardiac Surgery
Farzan Filsoufi, Parwis B. Rahmanian, Javier G. Castillo, Corey Scurlock, Peter E. Legnani, David H. Adams
Annals of Surgery; Volume 246, Issue 2, August 2007, Pages 323-329
Gastrointestinal complications following cardiac surgery remain rare with an incidence <1% in a contemporary series. The key to a lower incidence of GICs lies in systematic application of preventive measures and new advances in intraoperative management. Identification of independent risk factors would facilitate the determination of patients who would benefit from additional perioperative monitoring. Future resources should therefore be redirected to mitigate GICs in high-risk patients.
Early and Late Outcome of Cardiac Surgery in Patients With Liver Cirrhosis
Farzan Filsoufi, Sacha P. Salzberg, Parwis B. Rahmanian, Thomas D. Schiano, Hussien Elsiesy, Anthony Squire, David H. Adams
Liver Transplantation; Volume 13, Issue 7, July 2007, Pages 990 - 995
Liver cirrhosis is a major risk factor in general surgery. Few studies have reported on the outcome of cardiac surgery in these patients. Herein we report our recent experience in this high-risk patient population according to the Child-Turcotte-Pugh classification and Model for End-Stage Liver Disease (MELD) score. ... Our results suggest that cardiac surgery can be performed safely in patients with Child-Turcotte-Pugh class A and selected patients with class B. Operative mortality remains high in class C patients. Careful patient selection is critical in order to improve surgical outcome in patients with cirrhosis.
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Effective Management of Refractory Postcardiotomy Bleeding With the Use of Recombinant Activated Factor VII
Farzan Filsoufi, Javier G. Castillo, Parwis B. Rahmanian, Corey Scurlock, Gregory Fischer, David H. Adams
The Annals of Thoracic Surgery; Volume 82, Issue 5, November 2006, Pages 1779-1783
Severe coagulopathy after cardiovascular surgery may lead to intractable bleeding and is associated with increased mortality and morbidity. Recent studies have suggested that recombinant activated factor VII (rFVIIa) may play a role in decreasing postoperative bleeding. ... This study suggests that rFVIIa is safe and efficacious in the management of refractory postcardiotomy bleeding. The use of rFVIIa is associated with reduced blood loss, rapid improvement of coagulation variables, and decreased need for blood products.
The Modern Surgical Management of Atrial Fibrillation
Anil K. Gehi, David H. Adams, Farzan Filsoufi
The Mount Sinai Journal of Medicine; Volume 73, Number 5, Pages 751-758
The much simplified surgical treatment of atrial fibrillation using a modified maze procedure has been safe and effective thus far, and should therefore be offered to all mitral valve surgery patients with a history of paroxysmal, persistent, or permanent atrial fibrillation.
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