Publications by authors named "Can Yerebakan"

91 Publications

Cardiovascular basic science in 2020: A view through AATS journals.

J Thorac Cardiovasc Surg 2021 Aug 4;162(2):366-368. Epub 2021 May 4.

Division of Cardiac Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.04.084DOI Listing
August 2021

Developments in perioperative management: The yin to the yang of congenital heart surgery.

J Thorac Cardiovasc Surg 2021 Aug 23;162(2):432-434. Epub 2021 May 23.

Division of Cardiac Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.05.027DOI Listing
August 2021

Fontan on stage: The year 2020.

J Thorac Cardiovasc Surg 2021 08 22;162(2):369-371. Epub 2021 Apr 22.

Division of Cardiac Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC.

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http://dx.doi.org/10.1016/j.jtcvs.2021.04.047DOI Listing
August 2021

At the forefront of congenital cardiothoracic surgery: 2020-2021.

J Thorac Cardiovasc Surg 2021 Jul 20;162(1):178-182. Epub 2021 Apr 20.

Department of Cardiothoracic Surgery, University of Louisville and Norton Children's Hospital, Louisville, Ky.

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http://dx.doi.org/10.1016/j.jtcvs.2021.03.108DOI Listing
July 2021

Anomalous Right Coronary Artery off the Pulmonary Artery Strikes When You Least Expect It!

CASE (Phila) 2021 Apr 19;5(2):110-114. Epub 2020 Dec 19.

Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia.

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http://dx.doi.org/10.1016/j.case.2020.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071823PMC
April 2021

Commentary: Flowers against nonflowers.

J Thorac Cardiovasc Surg 2021 Apr 1. Epub 2021 Apr 1.

Department of Cardiology, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC.

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http://dx.doi.org/10.1016/j.jtcvs.2021.03.089DOI Listing
April 2021

Emergency surgical stent retrieval following stent dislodgement during ductal stenting for hybrid palliation.

Interact Cardiovasc Thorac Surg 2021 05;32(5):825-827

Department of Cardiovascular Surgery, Children's National Hospital, Washington, DC, USA.

Stenting of the ductus arteriosus is part of the hybrid treatment of high-risk patients with hypoplastic left heart syndrome. Dislodgement of a ductal stent is a rare complication. We present challenges faced in successful surgical retrieval of a dislodged ductal stent in a high-risk infant undergoing hybrid palliation for hypoplastic left heart syndrome.
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http://dx.doi.org/10.1093/icvts/ivaa337DOI Listing
May 2021

Commentary: Combine the right size with the right shape.

J Thorac Cardiovasc Surg 2021 07 30;162(1):206-207. Epub 2020 Nov 30.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC.

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http://dx.doi.org/10.1016/j.jtcvs.2020.11.080DOI Listing
July 2021

Commentary: Once again-the heart and the brain.

J Thorac Cardiovasc Surg 2020 Nov 30. Epub 2020 Nov 30.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.11.079DOI Listing
November 2020

Commentary: If only we knew when we would fail.

J Thorac Cardiovasc Surg 2021 04 23;161(4):1436-1437. Epub 2020 Jul 23.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC.

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http://dx.doi.org/10.1016/j.jtcvs.2020.07.059DOI Listing
April 2021

Commentary: Less Bloody and Bloodless Cases.

Semin Thorac Cardiovasc Surg 2021 7;33(2):513-514. Epub 2020 Nov 7.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.

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http://dx.doi.org/10.1053/j.semtcvs.2020.11.012DOI Listing
July 2021

Surgical pericardial adhesions do not preclude minimally invasive epicardial pacemaker lead placement in an infant porcine model.

J Cardiovasc Electrophysiol 2020 11 31;31(11):2975-2981. Epub 2020 Aug 31.

Division of Cardiology, Children's National Hospital, Washington, DC.

Background: Pericardial adhesions in infants and small children following cardiac surgery can impede access to the epicardium. We previously described minimally invasive epicardial lead placement under direct visualization in an infant porcine model using a single subxiphoid incision. The objective of this study was to assess the acute feasibility of this approach in the presence of postoperative pericardial adhesions.

Methods: Adhesion group piglets underwent left thoracotomy with pericardiotomy followed by a recovery period to develop pericardial adhesions. Control group piglets did not undergo surgery. Both groups underwent minimally invasive epicardial lead placement using a 2-channel access port (PeriPath) inserted through a 1 cm subxiphoid incision. Under direct thoracoscopic visualization, pericardial access was obtained with a 7-French sheath, and a pacing lead was affixed against the ventricular epicardium. Sensed R-wave amplitudes, lead impedances and capture thresholds were measured.

Results: Eight piglets underwent successful pericardiectomy and developed adhesions after a median recovery time of 45 days. Epicardial lead placement was successful in adhesion (9.5 ± 2.7 kg, n = 8) and control (5.6 ± 1.5 kg, n = 7) piglets. There were no acute complications. There were no significant differences in capture thresholds or sensing between groups. Procedure times in the adhesion group were longer than in controls, and while lead impedances were significantly higher in the adhesion group, all were within normal range.

Conclusions: Pericardial adhesions do not preclude minimally invasive placement of epicardial leads in an infant porcine model. This minimally invasive approach could potentially be applied to pediatric patients with prior cardiac surgery.
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http://dx.doi.org/10.1111/jce.14724DOI Listing
November 2020

Commentary: Flow Through Dynamic Thinking.

Semin Thorac Cardiovasc Surg 2020 2;32(4):893-894. Epub 2020 Aug 2.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.

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http://dx.doi.org/10.1053/j.semtcvs.2020.06.051DOI Listing
February 2021

Determinants of neurological outcome in neonates with congenital heart disease following heart surgery.

Pediatr Res 2021 Apr 25;89(5):1283-1290. Epub 2020 Jul 25.

Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA.

Background: The objective was to determine the association between perioperative risk factors and brain imaging abnormalities on neurologic outcome in neonates with hypoplastic left heart syndrome (HLHS) or d-Transposition of the great arteries (d-TGA) who underwent cardiac surgery including cardiopulmonary bypass.

Methods: A retrospective analysis of neonates with HLHS or d-TGA undergoing cardiac surgery including cardiopulmonary bypass between 2009 and 2017 was performed. Perioperative risk factors and Andropoulos' Brain Injury Scores from pre- and postoperative brain magnetic resonant images (MRI) were correlated to outcome assessments on patients between 5 and 23 months of age. Neurologic outcome was measured using the Pediatric Stroke Outcome Measure (PSOM) and Pediatric Version of the Glasgow Outcome Scale-Extended (GOS-E).

Results: Fifty-three neonates met our enrollment criteria (24 HLHS, 29 d-TGA). Mechanical ventilation > 12 days and DHCA > 40 min were associated with worse outcome. MRI measures of brain injuries were not associated with worse outcome by PSOM or GOS-E.

Conclusion: For HLHS and d-TGA patients, duration of mechanical ventilation and DHCA are associated with adverse neurologic outcome. Neonatal brain MRI commonly demonstrates acquired brain injuries, but the clinical impact of these abnormalities are not often seen before 2 years of age.

Impact: Acquired brain injury is common in high-risk neonates with CHD but poor neurological outcome was not predicted by severity of injury or lesion subtype. Longer stay in ICU is associated with postoperative brain injuries on MRI. Total duration of ventilation > 12 days is predictive of adverse neurological outcome scores. DHCA > 40 min is associated with adverse neurological outcome scores. Neurological outcome before 2 years of age is more affected by the clinical course than by cardiac diagnosis.
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http://dx.doi.org/10.1038/s41390-020-1085-1DOI Listing
April 2021

Brain and Congenital Heart Disease-Together in Good Times and Bad.

Semin Thorac Cardiovasc Surg 2020 29;32(4):945-946. Epub 2020 Jun 29.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Electronic address:

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http://dx.doi.org/10.1053/j.semtcvs.2020.06.018DOI Listing
February 2021

Right Atrial Cannulation via Thoracotomy for Emergent Extracorporeal Membrane Oxygenation in Pediatric Patients with Prior Sternotomy.

ASAIO J 2021 02;67(2):e64-e68

From the Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine, Washington, DC.

Extracorporeal membrane oxygenation (ECMO) is the most common mechanical circulatory support strategy used to treat pediatric patients presenting with low cardiac output or cardiogenic shock. While transthoracic central cannulation is feasible and mostly utilized for early postoperative support, peripheral cannulation is preferred as a primary strategy in the late postoperative period. Redo-sternotomy and venous cannulation are difficult to achieve in patients with occluded peripheral veins or complex venous anatomy like Glenn circulation. In pediatric patients with multiple prior sternotomy and catheterization procedures, vascular access for cannulation is frequently limited. Peripheral cannulation for venoarterial ECMO (VA-ECMO) may be challenging or even impossible. In our case series, four pediatric patients with prior sternotomy underwent right atrial cannulation emergently in patients to secure venous drainage for ECMO support. Extracorporeal membrane oxygenation support could be established rapidly with adequate venous drainage in all cases. We conclude that right atrial cannulation via right thoracotomy can be a useful technique for venous cannulation in cases with prior sternotomy and is particularly useful in cases with Glenn circulation.
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http://dx.doi.org/10.1097/MAT.0000000000001170DOI Listing
February 2021

Commentary: Continue to imitate the nature: We are getting closer.

Authors:
Can Yerebakan

J Thorac Cardiovasc Surg 2020 06 22;159(6):2381-2382. Epub 2020 Jan 22.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2019.12.105DOI Listing
June 2020

Commentary: Crawling toward heart transplantation and beyond.

J Thorac Cardiovasc Surg 2020 06 9;159(6):2426-2427. Epub 2019 Dec 9.

Departments of Cardiology and Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC.

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http://dx.doi.org/10.1016/j.jtcvs.2019.11.080DOI Listing
June 2020

Inflow cannula obstruction in Berlin Heart Excor and novel extracorporeal membrane oxygenation cannulation for rescue.

Int J Artif Organs 2020 Sep 29;43(9):625-628. Epub 2020 Jan 29.

Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, Washington, DC, USA.

Utilization of Berlin Excor as a pediatric bridge to transplantation device continues to increase. Thromboembolic complications continue to be an important morbidity related to ventricular assist devices. Obstructions to the device cannulae are rare but potentially life-threatening complications of ventricular assist devices, but inflow cannula obstruction is hitherto unreported. We present a case of a 4-year-old supported with Berlin BiVAD who demonstrated acute decompensation related to thrombus within the left atrial cannula. We describe the diagnosis, intervention, as well as novel rescue using existing cannulae for extracorporeal membrane oxygenation support.
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http://dx.doi.org/10.1177/0391398820901828DOI Listing
September 2020

Commentary: The oxygen metabolism of the brain transparent.

J Thorac Cardiovasc Surg 2020 05 24;159(5):2024-2025. Epub 2019 Sep 24.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2019.09.052DOI Listing
May 2020

Levels of agreement between cardiac magnetic resonance and conductance catheter measurements of right ventricular volumes after pulmonary artery banding.

Acta Radiol 2020 Jul 21;61(7):894-902. Epub 2019 Nov 21.

Department of Cardiac Surgery, University Clinic, Rostock, Germany*Equal contributors.

Background: Pressure-volume analysis is the gold standard for quantifying pump function of the right ventricle (RV); however, volume measurements based on a conductive catheter may be imprecise. The reference method for volume assessment is cardiac magnetic resonance (CMR).

Purpose: To determine the levels of agreement between RV volume measurements obtained by cine CMR, phase-contrast CMR (PC CMR), and a conductance catheter in an animal model.

Material And Methods: CMR was performed in 20 sheep three months after pulmonary artery banding. Ejection fraction (EF), end-diastolic (EDV), end-systolic (ESV), and stroke volumes (SV) were obtained by cine CMR and conductance catheter.

Results: Statistically significant differences between cine CMR and conductance catheter derived volume measurements were found for EDV ( < 0.001), ESV ( < 0.05), and SV ( < 0.05). Bland-Altman analysis showed very poor agreement between the two methods: EDV, bias 36.27 mL, agreement of limits 1.96-70.57 mL; ESV, bias 15.33 mL, agreement of limits -6.89-37.55 mL; and SV, bias 20.69 mL, agreement of limits 8.01-49.10 mL. Good agreement was found for SV between cine CMR and PC CMR (bias -7.0 mL, agreement of limits -24.01-9.98 mL), while SV derived from PC CMR measurements showed poor agreement with conductance catheter (bias 27.76 mL, agreement of limits -3.84-59.26 mL).

Conclusion: Poor agreement between the conductance catheter and CMR RV volume measurements was found. PC CMR and cine CMR measurements of SV agreed well.
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http://dx.doi.org/10.1177/0284185119886318DOI Listing
July 2020

Commentary: Myocardial regeneration with stem cells-Hope was never the problem!

J Thorac Cardiovasc Surg 2019 12 22;158(6):1624-1625. Epub 2019 Aug 22.

Department of Cardiovascular Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2019.07.071DOI Listing
December 2019

Effects of pulmonary artery banding in doxorubicin-induced left ventricular cardiomyopathy.

J Thorac Cardiovasc Surg 2019 06 2;157(6):2416-2428.e4. Epub 2019 Mar 2.

Pediatric Heart Center Giessen, Justus-Liebig-University, Giessen, Germany.

Objective: Central pulmonary banding has been proposed as a novel alternative for the treatment of left ventricular dilated cardiomyopathy in children. We sought to investigate the effects of central pulmonary banding in an experimental model of doxorubicin-induced left ventricular dilated cardiomyopathy.

Methods: Four-month-old sheep (n = 28) were treated with intermittent intracoronary injections of doxorubicin (0.75 mg/kg/dose) into the left main coronary artery. A total dose of up to 2.15 mg/kg of doxorubicin was administered until signs of left ventricular dilation with functional impairment occurred by transthoracic echocardiography evaluation. Animals that survived were treated with surgical central pulmonary banding through a left anterior thoracotomy or sham surgery. Transthoracic echocardiography and pressure-volume loop measurements were used to compare left ventricular function preoperatively and 3 months later. Macroscopic and microscopic histologic examinations followed after hearts were harvested.

Results: Nine animals from the central pulmonary banding group and 8 animals from the sham group survived and were included in the final analysis. Both groups showed similar inflammation and fibrosis upon histologic examination consistent with the toxic myocardial effects of doxorubicin. There were no differences in the echocardiographic measurements before central pulmonary banding or sham operation. Baseline measurements before the central pulmonary banding/sham operation were considered as 100%. The central pulmonary banding group had better left ventricular ejection fraction (102.5% ± 21.6% vs 76.7% ± 11.7%, P = .01), with a tendency for smaller left ventricular end-diastolic (101.2% ± 7.4% vs 120.4% ± 10.8%, P = .18) and significantly smaller end-systolic (100.3% ± 12.9% vs 116.5 ± 9.6%, P = .02) diameter of the left ventricle in comparison with the sham animals at 3 months. The end-systolic volume (101.4% ± 31.6% vs 143.4% ± 28.6%, P = .02) was significantly lower in the central pulmonary banding group 3 months postoperatively. Fractional shortening in the long axis (118.5% ± 21.5% vs 85.2% ± 22.8%, P = .016) and short axis (122.5% ± 18% vs 80.9% ± 13.6%, P = .0005) revealed significantly higher values in the central pulmonary banding group. In the conductance catheter measurements, no significant differences were seen between the groups for the parameters of systolic and diastolic function.

Conclusions: Central pulmonary artery banding in the setting of experimental toxic left ventricular dilated cardiomyopathy improved left ventricular echocardiographic function and dimensions.
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http://dx.doi.org/10.1016/j.jtcvs.2019.01.138DOI Listing
June 2019

Complete unroofing of the intramural coronary artery for anomalous aortic origin of a coronary artery: The role of commissural resuspension?

J Thorac Cardiovasc Surg 2019 07 2;158(1):208-217.e2. Epub 2019 Mar 2.

Department of Cardiovascular Surgery, Children's National Health System, Washington, DC. Electronic address:

Objectives: Although surgical repair of an anomalous aortic origin of the coronary artery has low operative mortality, longer-term risk of ischemia and aortic regurgitation remains concerning. We routinely perform aortic commissure resuspension after unroofing and sought to evaluate the outcomes with regard to aortic valve competence, symptoms, and signs of ischemia with this approach.

Methods: Twenty-six consecutive patients who received the unroofing procedure for anomalous aortic origin of the coronary artery (10 left; 16 right) between 2004 and 2016 were reviewed. In addition to complete unroofing of the intramural coronary, patients early in the cohort (n = 9) received unroofing only, and aortic commissural resuspension was performed routinely in the subsequent patients (n = 17). Outcomes between commissural resuspension versus no commissural resuspension were compared. The occurrence of mild and greater aortic regurgitation was assessed using a time-to-event analysis after varying lengths of time. Commissural resuspension was considered as the predictor, and the groups were compared using a log-rank test.

Results: There was no operative mortality. One patient in the no commissural resuspension group died 10 years later of prosthetic aortic valve endocarditis (aortic valve replacement 7 years after unroofing). The follow-up duration was 6.9 years (4.9-9.1) and 3.7 years (2.1-4.3) in the no commissural resuspension and commissural resuspension groups, respectively (P = .001). Available postoperative exercise stress test data (n = 14) revealed that 50% had an endurance level at the 25th percentile or greater for age. After a median follow-up of 1.9 years (3 months to 10.6 years), no patient in the commissural resuspension group had aortic regurgitation, whereas 6 of 9 patients (67%) in the no commissural resuspension group had stable but mild or greater aortic regurgitation. Time-to-event analysis with the primary event of occurrence of mild or greater aortic regurgitation showed significantly higher freedom from the occurrence of aortic regurgitation in the commissural resuspension group (P = .035).

Conclusions: Surgical repair of an anomalous aortic origin of the coronary artery can be performed with excellent early and midterm outcomes. Routine commissural resuspension of the aortic valve may lead to a lower rate of aortic valve regurgitation without increasing the risk of ischemia.
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http://dx.doi.org/10.1016/j.jtcvs.2019.01.140DOI Listing
July 2019

Commentary: Postoperative time to arrest-A new metric?

J Thorac Cardiovasc Surg 2019 06 20;157(6):e407-e408. Epub 2019 Feb 20.

Department of Cardiovascular Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2019.02.009DOI Listing
June 2019

Right Ventricular Function After Pulmonary Artery Banding: Adaptive Processes Assessed by CMR and Conductance Catheter Measurements in Sheep.

J Cardiovasc Transl Res 2019 10 7;12(5):459-466. Epub 2019 Mar 7.

Department of Cardiac Surgery, University Clinic, Schillingallee 35, 10857, Rostock, Germany.

This experimental study describes the adaptive processes of the right ventricular (RV) myocardium after pulmonary artery banding (PAB) evaluated by cine cardiac magnetic resonance (CMR), phase-contrast CMR (PC-CMR), and conductance catheter. Seven sheep were subjected to CMR 3 months after PAB. Conductance catheter measurements were performed before and 3 months after PAB. Four nonoperated, healthy, age-matched animals served as controls. Higher RV masses (p < 0.01), elevated RV end-systolic volumes (p < 0.05), and lower RV ejection fraction (p < 0.01) were observed in the operated group. The time-to-peak pulmonary artery flow was longer in the banding group (p < 0.01). RV maximal pressure and RV end-diastolic pressure correlated with the time-to-peak flow in the pulmonary artery (r = - 0.70 and - 0.69, respectively). In summary, PAB caused RV hypertrophy, increased myocardial contractility, and decreased RV-EF and cardiac output. The time-to-peak pulmonary artery flow correlated with RV pressures.
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http://dx.doi.org/10.1007/s12265-019-09881-6DOI Listing
October 2019

Commentary: Dream big in every small step.

J Thorac Cardiovasc Surg 2019 08 11;158(2):532-533. Epub 2019 Jan 11.

Department of Cardiovascular Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2018.12.086DOI Listing
August 2019

Failing Fontan assist: From tissue to turbine.

J Thorac Cardiovasc Surg 2018 11 5;156(5):1947-1948. Epub 2018 Sep 5.

Department of Cardiovascular Surgery, Children's National Heart Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2018.08.060DOI Listing
November 2018

Intra-Extracardiac Versus Extracardiac Fontan Modifications: Comparison of Early Outcomes.

Ann Thorac Surg 2019 02 28;107(2):560-566. Epub 2018 Sep 28.

Department of Cardiovascular Surgery, Children's National Health System, Washington, DC. Electronic address:

Background: The intra-extracardiac (IE) Fontan modification has advantages over the lateral tunnel modification. A direct comparison of IE to the extracardiac (EC) modification so far has not been done. This study compared IE to EC Fontan with respect to early postoperative outcomes.

Methods: We retrospectively compared outcomes of the Fontan operation using the IE or EC conduit modification between January 2012 and December 2016. IE and EC groups were compared using univariate and multivariable regression analysis. To eliminate the confounding effects of fenestration, repeat intergroup comparison was performed after excluding nonfenestrated patients.

Results: There were 81 patients grouped according to Fontan modification into the IE group (n = 43) or EC group (n = 38). The Fontan was fenestrated in 100% of the IE group but in only 55% of the EC group (p < 0.001). Cardiopulmonary bypass time was shorter for the IE group (74 vs 103, p < 0.001) The IE patients had median cross-clamp time of 34 minutes, whereas only 2 patients in the EC group required cross-clamping (35 and 95 minutes; p < 0.001). The IE group had significantly shorter median duration of pleural effusion (8 days vs 11 days, p = 0.007) and hospital length of stay (9 days vs 13 days, p = 0.001) than the EC group. Multivariable linear regression analysis revealed that the IE modification was independently associated with reduced duration of pleural effusion (p = 0.004) and hospital length of stay (p = 0.003). Presence of any unfavorable hemodynamics on preoperative assessment was also associated with longer duration of pleural effusion and hospital length of stay for patients with fenestration.

Conclusions: The IE Fontan modification may be associated with reduced duration of postoperative pleural effusion and hospital length of stay compared with the EC modification.
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http://dx.doi.org/10.1016/j.athoracsur.2018.07.080DOI Listing
February 2019

The never-ending story of the ideal valve.

J Thorac Cardiovasc Surg 2019 02 3;157(2):726-727. Epub 2018 Aug 3.

Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, DC.

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http://dx.doi.org/10.1016/j.jtcvs.2018.07.076DOI Listing
February 2019
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