Publications by authors named "Erik E Lewis"

6 Publications

  • Page 1 of 1

Prognosis of paradoxical low-flow low-gradient aortic stenosis after transcatheter aortic valve replacement.

J Cardiovasc Med (Hagerstown) 2021 Jun;22(6):486-491

Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Aims: In paradoxical low-flow low-gradient severe aortic stenosis (PLFLG AS) patients, stroke volume index (SVI) is reduced despite preserved left ventricular ejection fraction (LVEF). Although reduced SVI is already known as a poor prognostic predictor, the outcomes of PLFLG AS patients after transcatheter aortic valve replacement (TAVR) have not been clearly defined. We retrospectively investigated the post-TAVR outcomes of PLFLG AS patients in comparison with normal-flow high-gradient aortic stenosis (NFHG AS) patients.

Methods: The current observational study included 245 patients with NFHG AS (mean transaortic pressure gradient ≥40 mmHg and LVEF ≥ 50%) and 48 patients with PLFLG AS (mean transaortic pressure gradient <40 mmHg, LVEF ≥ 50% and SVI < 35 ml/m2). The endpoints were all-cause mortality, hospitalization for valve-related symptoms or worsening congestive heart failure and New York Heart Association functional class III or IV.

Results: PLFLG AS patients had a significantly higher proportion with a history of atrial fibrillation/flutter as compared with NFHG AS patients. All-cause mortality of PLFLG AS patients was worse than that of NFHG AS patients (P = 0.047). Hospitalization for valve-related symptoms or worsening congestive heart failure was more frequent in PLFLG AS patients than in NFHG AS patients (P = 0.041). New York Heart Association functional class III-IV after TAVR was more frequently observed in PLFLG AS patients (P = 0.019).

Conclusion: The outcomes of PLFLG AS patients were worse than those of NFHG AS patients in this study. Preexisting atrial fibrillation/flutter was frequent in PLFLG AS patients, and may affect their post-TAVR outcomes. Therefore, closer post-TAVR follow-up should be considered for these patients.
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http://dx.doi.org/10.2459/JCM.0000000000001139DOI Listing
June 2021

The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement.

Intern Med 2021 Feb 7;60(4):517-523. Epub 2020 Oct 7.

Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA.

Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehospitalization, the New York Heart Association (NYHA) functional class and echocardiographic parameters were compared between patients <85 years old (n = 290) and ≥85 years old (n = 143). Results The patients ≥85 years old less frequently had a history of coronary artery disease (73.1% vs. 62.2%, p=0.026) and hypertension (87.2% vs. 77.6%, p=0.012) than younger patients. Furthermore, the patients ≥85 years old had moderate-severe mitral regurgitation more frequently (19.3% vs. 28.7%, p=0.037) at baseline than younger patients. There was no significant difference in in-hospital outcomes between the age groups. The 30-day mortality was worse in patients ≥85 years old than in younger ones (0.7% vs. 3.5%, p=0.042). While there was no significant difference in the long-term mortality between the 2 groups, the estimated 1-year mortality from Kaplan-Meier curves were 9.6% in patients <85 years old and 14.9% in patients ≥85 years old. The rate of in-hospital complications, rehospitalization rate, improvement in the NYHA functional class and echocardiographic parameters were comparable between the two groups. Conclusion The outcomes of super-elderly patients after TAVR were acceptable, suggesting that these patients could benefit from TAVR.
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http://dx.doi.org/10.2169/internalmedicine.5047-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946496PMC
February 2021

We Agree: Cardiopulmonary Bypass Is a Team Sport: Reply.

Ann Thorac Surg 2020 10 23;110(4):1437-1438. Epub 2020 Apr 23.

Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2020.03.055DOI Listing
October 2020

Cardiothoracic Education in the Time of COVID-19: How I Teach It.

Ann Thorac Surg 2020 08 10;110(2):362-363. Epub 2020 Apr 10.

Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2020.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151493PMC
August 2020

Cardiopulmonary Bypass: How I Teach It.

Ann Thorac Surg 2020 03 16;109(3):645-648. Epub 2020 Jan 16.

Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2020.01.001DOI Listing
March 2020

Circumferential Three-Dimensional-Printed Tracheal Grafts: Research Model Feasibility and Early Results.

Ann Thorac Surg 2017 Sep 13;104(3):958-963. Epub 2017 Jun 13.

Department of Otolaryngology, Mount Sinai West, Mount Sinai Health System, New York, New York.

Background: Methods for tracheal graft research have presented persistent challenges to investigators, and three-dimensional (3D)-printed biosynthetic grafts offer one potential development platform. We aimed to develop an efficient research platform for customizable circumferential 3D-printed tracheal grafts and evaluate feasibility and early structural integrity with a large-animal model.

Methods: Virtual 3D models of porcine subject tracheas were generated using preoperative computed tomography scans. Two designs were used to test graft customizability and the limits of the construction process. Designs I and II used 270-degree and 360-degree external polycaprolactone scaffolds, respectively, both encompassing a circumferential extracellular matrix collagen layer. The polycaprolactone scaffolds were made in a fused-deposition modeling 3D printer and customized to the recipient's anatomy. Design I was implanted in 3 pigs and design II in 2 pigs, replacing 4-ring tracheal segments. Data collected included details of graft construction, clinical outcomes, bronchoscopy, and gross and histologic examination.

Results: The 3D-printed biosynthetic grafts were produced with high fidelity to the native organ. The fabrication process took 36 hours. Grafts were implanted without immediate complication. Bronchoscopy immediately postoperatively and at 1 week demonstrated patent grafts and appropriate healing. All animals lived beyond a predetermined 1-week survival period. Bronchoscopy at 2 weeks showed significant paraanastomotic granulation tissue, which, along with partial paraanastomotic epithelialization, was confirmed on pathology. Overall survival was 17 to 34 days.

Conclusions: We propose a rapid, reproducible, resource efficient method to develop various anatomically precise grafts. Further graft refinement and strategies for granulation tissue management are needed to improve outcomes.
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http://dx.doi.org/10.1016/j.athoracsur.2017.03.064DOI Listing
September 2017
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