Publications by authors named "A Estrera"

360 Publications

Reappraisal of the role of motor and somatosensory evoked potentials during open distal aortic repair.

J Thorac Cardiovasc Surg 2021 Aug 20. Epub 2021 Aug 20.

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Tex. Electronic address:

Objective: Intraoperative motor and somatosensory evoked potentials have been applied to monitor spinal cord ischemia during repair. However, their predictive values remain controversial. The purpose of this study was to evaluate the impact of motor evoked potentials and somatosensory evoked potentials on spinal cord ischemia during open distal aortic repair.

Methods: Our group began routine use of both somatosensory evoked potentials and motor evoked potentials at the end of 2004. This study used a historical cohort design, using risk factor and outcome data from our department's prospective registry. Univariate and multivariable statistics for risk-adjusted effects of motor evoked potentials and somatosensory evoked potentials on neurologic outcome and model discrimination were assessed with receiver operating characteristic curves.

Results: Both somatosensory evoked potentials and motor evoked potentials were measured in 822 patients undergoing open distal aortic repair between December 2004 and December 2019. Both motor evoked potentials and somatosensory evoked potentials were intact for the duration of surgery in 348 patients (42%). Isolated motor evoked potential loss was observed in 283 patients (34%), isolated somatosensory evoked potential loss was observed in 18 patients (3%), and both motor evoked potential and somatosensory evoked potential loss were observed in 173 patients (21%). No spinal cord ischemia occurred in the 18 cases with isolated somatosensory evoked potential loss. When both signals were lost, signal loss happened in the order of motor evoked potentials and then somatosensory evoked potentials. Immediate spinal cord ischemia occurred in none of those without signal loss, 4 of 283 (1%) with isolated motor evoked potential loss, and 15 of 173 (9%) with motor evoked potential plus somatosensory evoked potential loss. Delayed spinal cord ischemia occurred in 12 of 348 patients (3%) with intact evoked potentials, 24 of 283 patients (8%) with isolated motor evoked potentials loss, and 27 of 173 patients (15%) with motor evoked potentials + somatosensory evoked potentials loss (P < .001). Motor evoked potentials and somatosensory evoked potentials loss were each independently associated with spinal cord ischemia. For immediate spinal cord ischemia, no return of motor evoked potential signals at the conclusion of the surgery had the highest odds ratio of 15.87, with a receiver operating characteristic area under the curve of 0.936, whereas motor evoked potential loss had the highest odds ratio of 3.72 with an area under the curve of 0.638 for delayed spinal cord ischemia.

Conclusions: Somatosensory evoked potentials and motor evoked potentials are both important monitoring measures to predict and prevent spinal cord ischemia during and after open distal aortic repairs. Intraoperative motor evoked potential loss is a risk for immediate and delayed spinal cord ischemia after open distal aortic repair, and somatosensory evoked potential loss further adds predictive value to the motor evoked potential.
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http://dx.doi.org/10.1016/j.jtcvs.2021.08.033DOI Listing
August 2021

Commentary: There is no "I" in team.

JTCVS Tech 2020 Sep 12;3:39-40. Epub 2020 Aug 12.

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, Tex.

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http://dx.doi.org/10.1016/j.xjtc.2020.07.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304845PMC
September 2020

Commentary: Sarcopenia is not just skeletal muscle loss.

J Thorac Cardiovasc Surg 2021 Jun 29. Epub 2021 Jun 29.

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.06.044DOI Listing
June 2021

Commentary: Is Resternotomy Proximal Aortic Repair Still a High-Risk Procedure?

Semin Thorac Cardiovasc Surg 2021 Jun 23. Epub 2021 Jun 23.

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas. Electronic address:

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http://dx.doi.org/10.1053/j.semtcvs.2021.06.019DOI Listing
June 2021

Gender Representation Among Principal Investigators in Cardiac Surgery Clinical Trials in the United States: The Glass Ceiling and Room for Improvement.

Ann Surg 2021 Jun 2. Epub 2021 Jun 2.

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada Division of Cardiac Surgery, Department of Surgery, John Hopkins University, Baltimore, MD Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX Division of Cardiothoracic Surgery, Michael E. DeBakey VA Medical Center, Houston, TX Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Surgery Section, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX.

Objective: To determine the gender representation among principal investigators (PIs) in US cardiac surgery clinical trials.

Summary Background Data: Being a principal investigator in a US clinical trial confers national recognition among peers. Gender representation among principal investigators (PIs) in US cardiac surgery clinical trials has not been evaluated.

Methods: We evaluated 124 US cardiac surgery trials registered on ClinicalTrials.gov from 2014 to 2019. Sixty trials included PIs (n = 266) from 128 institutions that had a combined total of 1040 adult cardiac surgeons. We examined gender representation among junior-level (instructor or assistant professor) and senior-level (associate, full, or Emeritus professor) PIs by calculating the participation-to-prevalence ratio (PPR), whereby a PPR range of 0.8-1.2 reflects equitable representation.

Results: The pool representation percentage was 6.1% (63/1040) for women and 93.9% (977/1040) for men. A total of 266 PI positions were assigned to adult cardiac surgeons: 6 (9.5%; PPR = 0.37) from the female pool and 260 (26.6%; PPR = 1.04) from the male pool (p = 0.004). The percentage of PIs with studies funded by industry was 9.5% of the female pool (PPR = 0.39) and 25.0% of the male pool (PPR = 1.04) (p = 0.009). No National Institutes of Health-funded or other funded trials had female PIs. An overall trend was observed towards disproportionally more men than women among PIs, especially at the senior level (p = 0.027).

Conclusions: Equitable opportunities for PI positions are available for junior-level but not senior-level cardiothoracic surgeons. These results suggest a need for active engagement and promotion of equal opportunities in cardiac surgery.
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http://dx.doi.org/10.1097/SLA.0000000000004961DOI Listing
June 2021
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