Publications by authors named "Emily A Farkas"

15 Publications

  • Page 1 of 1

Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

J Card Surg 2021 Sep 12;36(9):3040-3051. Epub 2021 Jun 12.

Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, California, USA.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

Methods: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed.

Results: Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID-19, they were most worried with exposing their family to COVID-19 (81%), followed by contracting COVID-19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID-19 burden, with higher COVID-19 burden institutions more likely to resort to PPE conservation strategies.

Conclusions: The present study demonstrates the impact of COVID-19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.
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http://dx.doi.org/10.1111/jocs.15681DOI Listing
September 2021

Emotional quality-of-life and patient-reported limitation in sports participation in children with uncorrected congenital and acquired heart disease in healthcare-restricted settings in low- and middle-income countries.

Cardiol Young 2020 Feb;30(2):188-196

CardioStart International, Tampa, FL, USA.

Background: Little is known about emotional quality-of-life in paediatric heart disease in low- and middle-income countries where the prevalence of uncorrected lesions is high. Research on emotional quality-of-life and its predictors in these settings is key to planning interventions.

Methods: Ten-year retrospective cross-sectional study of children aged 6-17 years with uncorrected congenital or acquired heart disease in 12 low- and middle-income countries was conducted. Emotional functioning score of the PedsQL TM 4.0 generic core scale and data on patient-reported limitation in sports participation were collected via in-person interview and analysed using regression analyses.

Results: Ninety-four children reported mean emotional functioning scores of 71.94 (SD 25.32) [95% CI 66.75-77.13] with lower scores independently associated with having a parent with a chronic illness or who had died (p = 0.005), having less than three siblings (p = 0.007), and reporting a subjective limitation in carrying an item equivalent to a 4 lb load (p = 0.021). Patient-reported limitation in sports participation at least "sometimes" was present in 69% and was independently associated with experiencing symptoms at least once a month (p < 0.001).

Conclusion: Some of the factors which were associated with better emotional quality-of-life were similar to those identified in previous studies in patients with corrected defects. Patient-reported limitation in sports participation is common. In addition to corrective surgery and exercise, numerous other interventions which are practicable during surgical missions might improve emotional quality-of-life.
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http://dx.doi.org/10.1017/S1047951120000220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332412PMC
February 2020

The Disparity Between Public Utilization and Surgeon Awareness of the STS Patient Education Website.

Ann Thorac Surg 2020 07 19;110(1):284-289. Epub 2019 Nov 19.

Society for Thoracic Surgeons Media Office, Chicago, Illinois.

Background: Many online resources currently provide healthcare information to the public. In 2015, the Society of Thoracic Surgeons (STS) created a multimedia web portal (ctsurgerypatients.org) to educate the public regarding cardiothoracic surgery and provide an informative tool to which cardiothoracic surgeons could refer patients.

Methods: A patient education task force was created, and disease-specific content was created for 25 pathological conditions. After launching the website online, a marketing campaign was initiated to make STS members aware of its availability. Website visits were monitored, and an online survey for public users was created. An email survey was sent to STS members to evaluate awareness and content. Surveys were analyzed for effectiveness and utilization by both public users and STS member surgeons.

Results: From 2016 to 2018, the website had more than 1 million visits, with visits increasing yearly. Surveyed user ratings of the website were positive regarding quality and utility of the information provided. STS member response was poor (379 responses of 6347 emails), and 78.3% of responders were unaware of the website. Surgeon responders were positive about the content, though many still refrain from referring patients.

Conclusions: Online education for cardiothoracic surgery is seeing increased public use, with high ratings for content and utility. Despite aggressive marketing to STS members, most remain unaware of this website's existence. Those who are aware approve of its content, but adoption of referring patients to it has been slow. Improved strategies are necessary to make surgeons aware of this STS-provided service and increase patient referrals to it.
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http://dx.doi.org/10.1016/j.athoracsur.2019.09.074DOI Listing
July 2020

Humanitarian Outreach in Cardiothoracic Surgery: From Setup to Sustainability.

Ann Thorac Surg 2016 Sep 17;102(3):1004-1011. Epub 2016 Jun 17.

Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas.

Noncommunicable diseases account for 38 million deaths each year, and approximately 75% of these deaths occur in the developing world. The most common causes include cardiovascular diseases, cancer, respiratory diseases, and diabetes mellitus. Many adults with acquired cardiothoracic disease around the world have limited access to health care. In addition, congenital heart disease is present in approximately 1% of live births and is therefore the most common congenital abnormality. More than one million children in the world are born with congenital heart disease each year, and approximately 90% of these children receive suboptimal care or have no access to care. Furthermore, many children affected by noncongenital cardiac conditions also require prevention, diagnosis, and treatment. Medical and surgical volunteerism can help facilitate improvement in cardiothoracic health care in developing countries. As we move into the future, it is essential for physicians and surgeons to be actively involved in political, economic, and social aspects of society to serve health care interests of the underprivileged around the world. Consequently, in developing countries, a critical need exists to establish an increased number of reputable cardiothoracic programs and to enhance many of the programs that already exist. The optimal strategy is usually based on a long-term educational and technical model of support so that as case volumes increase, quality improves and mortality and morbidity decrease. Humanitarian outreach activities should focus on education and sustainability, and surgical tourism should be limited to those countries that will never have the capability to have free-standing cardiothoracic programs.
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http://dx.doi.org/10.1016/j.athoracsur.2016.03.062DOI Listing
September 2016

How Often Do You Perform Aortic Valve Repair?

Aorta (Stamford) 2014 Feb 1;2(1):41-2. Epub 2014 Feb 1.

(on behalf of the Editorial Office).

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http://dx.doi.org/10.12945/j.aorta.2014.14-008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682690PMC
February 2014

Conduits for coronary bypass: vein grafts.

Korean J Thorac Cardiovasc Surg 2012 Oct 9;45(5):275-86. Epub 2012 Oct 9.

Division of Cardiothoracic Surgery, St. Louis University Hospital, USA.

The saphenous vein has been the principal conduit for coronary bypass grafting from the beginning, circa 1970. This report briefly traces this history and concomitantly presents one surgeons experience and personal views on use of the vein graft. As such it is not exhaustive but meant to be practical with a modest number of references. The focus is that of providing guidance and perspective which may be at variance with that of others and recognizing that there may be many ways to accomplish the task at hand. Hopefully the surgeon in training/early career may find this instructive on the journey to surgical maturity.
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http://dx.doi.org/10.5090/kjtcs.2012.45.5.275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487010PMC
October 2012

Are thromboembolic and bleeding complications a drawback for composite aortic root replacement?

Ann Thorac Surg 2012 Sep 23;94(3):737-43. Epub 2012 May 23.

Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.

Background: Valve-preserving aortic root reconstruction is being performed with increasing frequency. Independent of durability concerns, enthusiasm for retaining the native valve is often championed on the presumption that composite graft replacement of the aorta will be complicated by thromboembolism and bleeding. Our goal in this late follow-up study is to determine if thromboembolism or bleeding, or both, are indeed problematic after composite aortic root replacement.

Methods: Between 1995 and 2011, 306 patients (mean age, 56±14 years) underwent composite graft replacement of the aorta. St. Jude mechanical valve conduits (St. Jude Medical, St Paul, MN) were used in 242 patients, and 64 received a biologic conduit. Long-term postoperative follow-up (mean, 56 months; range, 1 to 97 months) was performed through our Aortic Database, supplemented by patient interviews and use of the Social Security Death Index.

Results: Hospital mortality was 2.9% overall and 1.4% in the last 8 years. Kaplan-Meier curves showed freedom (±standard deviation) from bleeding, stroke, and distal embolism as 94.3%±1.7% at 5 years and 91.3%±2.4% at 10 years. Survival was 93.5%±1.8% at 5 years and 80.9%±4.6% at 10 years, which was not statistically different from that for an age- and sex-matched population in Connecticut. Freedom from reoperation of the aortic root was 99% at 10 years.

Conclusions: Patients had excellent survival and few thromboembolic and bleeding complications after composite aortic root replacement. These data supporting minimal morbidity in the setting of well-established durability should be used to put alternative procedures, such as valve-preserving aortic root reconstruction, into context.
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http://dx.doi.org/10.1016/j.athoracsur.2012.04.007DOI Listing
September 2012

Intracoronary fiducial embolization after percutaneous placement for stereotactic radiosurgery.

Ann Thorac Surg 2012 May;93(5):1715-7

Division of Cardiothoracic Surgery, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA.

Although well established for the treatment of intracranial and prostatic pathology, stereotactic radiosurgery has only recently emerged as a modality for the treatment of malignant lung lesions. Utilization of radio-opaque markers, called fiducials, facilitate dose-intensive radiation focused on the tumor with sparing of surrounding normal tissue. There is a paucity of literature regarding complications that occur secondary to placement of these fiducials. The following report details a case in which intracoronary migration resulted in a hemodynamically significant acute coronary syndrome.
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http://dx.doi.org/10.1016/j.athoracsur.2011.08.057DOI Listing
May 2012

Biomarkers for diagnosis in thoracic aortic disease: CON.

Authors:
Emily A Farkas

Cardiol Clin 2010 May;28(2):213-20

Department of Surgery, Cardiothoracic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 8th Floor Des Loges Towers, St Louis, MO 63110, USA.

The fundamental requirements for a meaningful biomarker have not been met in the prediction of the aneurysm trait, the progression of the aneurysm disease state, or the prevention of catastrophic aortic complications. Aortic aneurysm is a worthy opponent on all fronts, and clinicians should continue actively to evaluate all potential diagnostic and therapeutic adjuncts with high levels of scientific scrutiny and rigor, so that the understanding and management of this disease process evolves in a complementary, rather than duplicative, manner. In the meantime, proteomics, genomics, and metabolomics continue to represent a muse of sorts in scientific circles, but clinicians are responsible for verifying the relevance and meaningful application of its postulates as they apply to individual patients within the context of efficient and effective global health care delivery.
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http://dx.doi.org/10.1016/j.ccl.2010.01.018DOI Listing
May 2010

Thoracic aortic aneurysm clinically pertinent controversies and uncertainties.

J Am Coll Cardiol 2010 Mar;55(9):841-57

Cardiac Surgery, Yale University School of Medicine, Boardman 2, 333 Cedar Street, New Haven, Connecticut 06510, USA.

This paper addresses clinical controversies and uncertainties regarding thoracic aortic aneurysm and its treatment. 1) Estimating true aortic size is confounded by obliquity, asymmetry, and noncorresponding sites: both echocardiography and computed tomography/magnetic resonance imaging are necessary for complete assessment. 2) Epidemiology of thoracic aortic aneurysm. There has been a bona fide increase in incidence of aortic aneurysm making aneurysm disease the 18th most common cause of death. 3) Aortic growth rate. Although a virulent disease, thoracic aortic aneurysm is an indolent process. The thoracic aorta grows slowly-0.1 cm/year. 4) Evidence-based intervention criteria. It is imperative to extirpate the thoracic aorta before rupture or dissection occurs; surgery at 5.0- to 5.5-cm diameter will prevent most adverse natural events. Symptomatic (painful) aneurysms must be resected regardless of size. 5) Development of nonsize criteria. Mechanical properties of the aorta deteriorate at the same 6 cm at which dissection occurs; elastic properties of the aorta may soon become useful intervention criteria. 6) Medical treatment of aortic aneurysm. Medical treatment is of unproven value, even beta-blockers and angiotensin-receptor blockers. 7) A genetic disease. Even non-Marfan aneurysms have a strong genetic basis. 8) Need for biomarkers. Virulent but silent, TAA cries out for a biomarker that can predict the onset of adverse events. Pathophysiologic understanding has led to identification of promising biomarkers, especially metalloproteinases. 9) Endovascular therapy for aneurysms. Endovascular therapy has burgeoned, despite the fact that the EVAR-2, DREAM, and INSTEAD trials showed no benefit at mid-term over medical or conventional surgical therapy. We must avoid "irrational exuberance." 10) Inciting events for acute aortic dissection. Recent evidence shows that dissections are preceded by a specific severe exertional or emotional event. 11) "Silver lining" of aortic disease. Proximal aortic root disease seems to protect against arteriosclerosis.
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http://dx.doi.org/10.1016/j.jacc.2009.08.084DOI Listing
March 2010

Assisted circulation: experience with the Novacor Left Ventricular Assist System.

Expert Rev Med Devices 2007 Nov;4(6):769-74

St. Louis University School of Medicine, Department of Surgery, Section of Cardiothoracic Surgery, 333 Cedar Street, FMB 121, New Haven, CT 06504, USA.

Surgical therapy for the treatment of heart failure is a relatively young solution to a problem that has overwhelmed civilizations dating back to the First Dynasty. Despite centuries of enormous multidisciplinary medical and technological advance, nearly 2000 people in the USA died of cardiovascular disease every day in 2006, averaging one death every 35 seconds, and claiming more lives than the next four leading causes of death combined. In 2007, one in 30 female deaths will be from breast cancer, while one in 2.6 will be from cardiovascular disease. The prevalence of heart failure in our population is a staggering 5 million in the USA and 6.5 million in Europe per year. Furthermore, based on the 44-year follow-up of the National Heart, Blood, and Lungs Institute Framingham Heart Study, 80% of men and 70% of women under the age of 65 years who have heart failure will die within 8 years. The focus of this article will be to review the history and future of the Novacor Left Ventricular Assist System as it relates to the failing heart; the story of how the innovator, the researcher, the engineer and the surgeon have come together to offer a surgical solution to a medical problem of inconceivable scope.
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http://dx.doi.org/10.1586/17434440.4.6.769DOI Listing
November 2007

Straight deep hypothermic arrest: experience in 394 patients supports its effectiveness as a sole means of brain preservation.

Ann Thorac Surg 2007 Sep;84(3):759-66; discussion 766-7

Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.

Background: The three methods of brain preservation for aortic arch surgery--straight deep hypothermic circulatory arrest (DHCA) without perfusion adjuncts, retrograde cerebral perfusion, and antegrade cerebral perfusion--remain controversial. Patients in this report underwent surgery solely with DHCA.

Methods: Straight DHCA at 19 degrees C was used in 394 patients (267 males, 127 females) during a 10-year period. Mean age was 61.3 years (range, 15 to 88 years). Eighty-seven cases (22.1%) were urgent or emergencies. Thirty-eight (9.6%) were performed for descending or thoracoabdominal pathology and the rest for ascending/arch (102 hemiarch, 49 total arch). Ninety-one patients (23.1%) had dissections. The head was packed in ice. No barbiturate coma was used.

Results: DHCA lasted a mean of 31.0 minutes (range, 10 to 66 minutes). Reexploration for bleeding was required in 4.5% (18/394). Overall mortality was 6.3% (25/394). Mortality was 3.6% (11/307) for elective cases and 16% (14/87) for emergency cases. The stroke rate was 4.8% (19/394). The seizure rate was 3.1% (12/394). Forty-five patients with high professional cognitive demands (MD, PhD, attorney, etc) performed without detriment postoperatively. Among patients with DHCA exceeding 40 minutes, the stroke rate was 13.1% (8/61); a neuroradiologist's review of brain computed tomography scans found 62.5% of these strokes (5/8) to be embolic and 37.5% (3/8) hypoperfusion related. By multivariable logistic regression, emergency operation and descending location increased morbidity and mortality.

Conclusions: Straight DHCA without adjunctive perfusion suffices as a sole means of cerebral protection. Stroke and seizure rates are low. Cognitive function, by clinical assessment, is excellent. Especially for straightforward ascending/arch reconstructions, there is little need for the added complexity of brain perfusion strategies.
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http://dx.doi.org/10.1016/j.athoracsur.2007.04.107DOI Listing
September 2007

Airway complications after pulmonary resection.

Thorac Surg Clin 2006 Aug;16(3):243-51

Division of Thoracic Surgery, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06520-8062, USA.

Airway complications following pulmonary resection remain a challenging problem. A high degree of clinical suspicion, contrasted CT imaging, and early reoperation are crucial in preserving viable lung parenchyma following the anatomic compromise of lobar torsion. Likewise, early recognition and expeditious drainage of the pleural space in the setting of bronchial dehiscence may help prevent the aspiration pneumonia and consequent respiratory failure that is the leading cause of death in this patient population; A variety of interventions to manage stump dehiscence are possible, but successful management still remains difficult and requires an individualized approach. Attention to technical details and avoidance of extensive dissection and tension should yield acceptably low rates of postoperative stenosis following bronchoplastic resection. These common themes of precise surgical technique, vigilance in the perioperative period, and classic sound judgment in addressing problems effectively and expeditiously remain pivotal in the minimization of sequelae from morbid airway complications.
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http://dx.doi.org/10.1016/j.thorsurg.2006.05.013DOI Listing
August 2006

A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules.

Am Surg 2002 Aug;68(8):678-82; discussion 682-3

Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.

Patients with a clinically concerning dominant thyroid nodule have been managed by lobectomy or total thyroidectomy at our institution. We determined the complications associated with both approaches and the ability of thyroid lobectomy to avoid the need for thyroid hormone replacement therapy. Records of all patients with a dominant thyroid nodule managed with surgery from August 1993 through December 2000 were reviewed for demographics, history of head and neck radiation, indication for surgery, preoperative fine-needle aspirate results, final pathologic evaluation, perioperative complications, determinations of need for subsequent thyroid surgery after lobectomy, and need for thyroid hormone replacement therapy after surgery. Patients with a preoperative diagnosis of malignancy or bilateral or diffuse disease were excluded because these conditions would uniformly be managed by bilateral thyroidectomy. The complications for the lobectomy group (n = 131) compared with the total thyroidectomy group (n = 84) were: recurrent laryngeal nerve paresis (4.6% vs 2.4%), recurrent laryngeal nerve injury (0.8% vs 0), and transient hypoparathyroidism (1.5% vs 9.5%; P = 0.007). No permanent hypoparathyroidism was identified in either group. Postoperative thyroid hormone replacement was required in 64 of 131 lobectomy patients (48.8%). Complications associated with either surgery were low. Total thyroidectomy was not associated with clinically significant additive morbidity. Patients treated by lobectomy should be aware of a nearly 50 per cent chance of requiring thyroid hormone replacement. Total thyroidectomy avoids future thyroid surgery; lobectomy patients remain at risk. When complications can be minimized total thyroidectomy should be considered an option in the management for patients with dominant thyroid nodules that require surgery.
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August 2002
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