Publications by authors named "Evan P Rotar"

9 Publications

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Commentary: Getting in the zone: Thoracic endovascular aortic repair safety in Ishimaru zones 0 and 1.

JTCVS Tech 2021 Jun 3;7:7-8. Epub 2021 Feb 3.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.

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http://dx.doi.org/10.1016/j.xjtc.2021.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311587PMC
June 2021

Commentary: When will the robots come marching in?

J Card Surg 2021 Jun 6. Epub 2021 Jun 6.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.

Minimally invasive techniques for coronary artery bypass grafting (CABG), specifically robotic-assisted CABG has increased in popularity despite conflicting evidence. Here, we review a report by Yokoyama and colleagues to the Journal of Cardiac Surgery investigating outcomes of robotic versus nonrobotic CABG utilizing the National Inpatient Sample (NIS).
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http://dx.doi.org/10.1111/jocs.15715DOI Listing
June 2021

Mixed type TAPVR-Measure twice, cut once.

J Card Surg 2021 Aug 1;36(8):2954-2955. Epub 2021 Jun 1.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.

Total anomalous pulmonary venous return (TAVR) can have varying drainage configurations. Here, we review a report by Nagulakonda et al. to the Journal of Cardiac Surgery detailing how additional computed tomography imaging revealed a mixed type presentation of TAPVR not identified on echocardiography.
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http://dx.doi.org/10.1111/jocs.15632DOI Listing
August 2021

Buy-In, Get More: Protocols to Increase Multi-Arterial Grafting Use.

J Am Coll Surg 2021 Jun;232(6):961-962

Charlottesville, VA.

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http://dx.doi.org/10.1016/j.jamcollsurg.2021.02.007DOI Listing
June 2021

Commentary: Planes, trains, and automobiles-Effective use of prolonged ex vivo heart preservation.

J Card Surg 2021 Jul 30;36(7):2596-2597. Epub 2021 Mar 30.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.

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http://dx.doi.org/10.1111/jocs.15520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187278PMC
July 2021

Secondary Burn Progression Mitigated by an Adenosine 2A Receptor Agonist.

J Burn Care Res 2021 Mar 26. Epub 2021 Mar 26.

Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.

Background: Current burn therapy is largely supportive with limited therapies to curb secondary burn progression. Adenosine 2A receptor (A2AR) agonists have anti-inflammatory effects with decreased inflammatory cell infiltrate and release of pro-inflammatory mediators. Using a porcine comb burn model, we examined whether A2AR agonists could mitigate burn progression.

Study Design: Eight full-thickness comb burns (4 prongs with 3 spaces per comb) per pig were generated with the following specifications: temperature 115° C, 3 kg force, and 30 second application time. In a randomized fashion, animals (4 per group) were then treated with A2AR agonist (ATL-1223, 3 ng/kg/min, intravenous infusion over 6 hours) or vehicle control. Necrotic interspace development was the primary outcome and additional histologic assessments were conducted.

Results: Analysis of unburned interspaces (72 per group) revealed that ATL-1223 treatment decreased the rate of necrotic interspace development over the first 4 days following injury (p<0.05). Treatment significantly decreased dermal neutrophil infiltration at 48 hours following burn (14.63±4.30 vs 29.71±10.76 neutrophils/high-power field, p=0.029). Additionally, ATL-1223 treatment was associated with fewer interspaces with evidence of microvascular thrombi through post-burn day 4 (18.8% vs 56.3%, p=0.002). Two weeks following insult, the depth of injury at distinct burn sites (adjacent to interspaces) was significantly reduced by ATL-1223 treatment (2.91±0.47 vs 3.28±0.58 mm, p=0.038).

Conclusion: This work demonstrates the ability of an A2AR agonist to mitigate burn progression through dampening local inflammatory processes. Extended dosing strategies may yield additional benefit and improve cosmetic outcome in those with severe injury.
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http://dx.doi.org/10.1093/jbcr/irab053DOI Listing
March 2021

Prediction of Prolonged Intensive Care Unit Length of Stay Following Cardiac Surgery.

Semin Thorac Cardiovasc Surg 2021 Mar 6. Epub 2021 Mar 6.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia. Electronic address:

Intensive care unit (ICU) costs comprise a significant proportion of the total inpatient charges for cardiac surgery. No reliable method for predicting intensive care unit length of stay following cardiac surgery exists, making appropriate staffing and resource allocation challenging. We sought to develop a predictive model to anticipate prolonged ICU length of stay (LOS). All patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery with a Society of Thoracic Surgeons (STS) predicted risk score were evaluated from an institutional STS database. Models were developed using 2014-2017 data; validation used 2018-2019 data. Prolonged ICU LOS was defined as requiring ICU care for at least three days postoperatively. Predictive models were created using lasso regression and relative utility compared. A total of 3283 patients were included with 1669 (50.8%) undergoing isolated CABG. Overall, 32% of patients had prolonged ICU LOS. Patients with comorbid conditions including severe COPD (53% vs 29%, P < 0.001), recent pneumonia (46% vs 31%, P < 0.001), dialysis-dependent renal failure (57% vs 31%, P < 0.001) or reoperative status (41% vs 31%, P < 0.001) were more likely to experience prolonged ICU stays. A prediction model utilizing preoperative and intraoperative variables correctly predicted prolonged ICU stay 76% of the time. A preoperative variable-only model exhibited 74% prediction accuracy. Excellent prediction of prolonged ICU stay can be achieved using STS data. Moreover, there is limited loss of predictive ability when restricting models to preoperative variables. This novel model can be applied to aid patient counseling, resource allocation, and staff utilization.
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http://dx.doi.org/10.1053/j.semtcvs.2021.02.021DOI Listing
March 2021

Surgical versus transcatheter mitral valve replacement in functional mitral valve regurgitation.

Ann Cardiothorac Surg 2021 Jan;10(1):75-84

Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.

Surgical mitral valve intervention for severe functional, or secondary mitral regurgitation is a viable option for patients deemed to be operative candidates and can be performed via traditional sternotomy or by minimally invasive techniques with similar outcomes. Transcatheter mitral valve replacement is an emerging technology with a potential role in the treatment of functional mitral valve regurgitation. A plethora of devices are currently in development and in various stages of clinical investigation. Operative approach to transcatheter mitral valve replacement varies from a percutaneous transseptal approach to a hybrid percutaneous/surgical apical approach. The Tendyne, Intrepid and Evoque systems show promising results from their early feasibility studies in treatment of patients with mitral regurgitation that were too high risk for surgery. In this review, we describe considerations for surgical and transcatheter mitral valve replacement for functional mitral valve regurgitation.
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http://dx.doi.org/10.21037/acs-2020-mv-217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867424PMC
January 2021

Commentary: Predictors of postoperative adverse events after cone reconstruction for Ebstein's anomaly.

J Card Surg 2021 Mar 27;36(3):1018-1019. Epub 2021 Jan 27.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.

Prediction scores and metrics are being increasingly utilized throughout the fields of cardiothoracic and congenital cardiac surgery to identify areas for perioperative optimization or guide therapeutic intent. Here, we review a novel submission by Yang and colleagues to the Journal of Cardiac Surgery identifying preoperative factors that predict adverse postoperative outcomes from cone reconstruction for Ebstein's anomaly.
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http://dx.doi.org/10.1111/jocs.15376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115025PMC
March 2021
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