Publications by authors named "Jason Han"

253 Publications

An Idea Whose Time Has Come.

Ann Thorac Surg 2021 Jun 21. Epub 2021 Jun 21.

Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA.

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http://dx.doi.org/10.1016/j.athoracsur.2021.05.070DOI Listing
June 2021

Escaping the Labyrinth - On Finding a Common Path Forward in the ICU.

N Engl J Med 2021 Jun 12;384(24):2269-2271. Epub 2021 Jun 12.

From the Department of Surgery, Division of Cardiovascular Surgery (J.J.H.), and the Department of Anesthesiology and Critical Care (J.M.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.

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http://dx.doi.org/10.1056/NEJMp2103422DOI Listing
June 2021

Assessing predicted heart mass size matching in obese heart transplant recipients.

J Heart Lung Transplant 2021 May 12. Epub 2021 May 12.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

Background: Predicted heart mass (PHM) is currently the most reliable metric for donor-recipient size matching in heart transplantation. Undersizing PHM donor-recipient match more than 20% independently predicts reduced survival. However, it is unclear if this is the case in obese recipients, in whom size matching can be challenging. We examined the use of PHM undersized hearts in obese recipients and assessed its impact on survival.

Methods: The United Network for Organ Sharing database was queried for adult patients undergoing heart transplantation from 1995 to 2020. Obese recipients (BMI ≥ 30) were categorized based on donor-recipient PHM match ≤-20% (undersized) or >-20% (size-matched). Nearest-neighbor propensity score matching was performed to adjust for baseline differences between cohorts. Temporal outcomes were compared by Kaplan-Meier survival analysis.

Results: A total of 13,668 obese recipients met inclusion criteria, with 9.6% receiving undersized and 90.4% receiving size-matched hearts. The proportion of undersized donor hearts in obese recipients significantly decreased over the study period (16.2% [1995] to 7.4% [2019], NP-trend < 0.001). Propensity-score matching resulted in 984 well-matched pairs of undersized and size-matched obese recipients. Recipients of undersized hearts saw similar 30-day mortality (5.5% vs 6.0%, p= 0.11) and re-transplantation rates (1.2% vs 1.2%, p = 1.00) as size-matched recipients. Survival at 1 year (88.4% vs 87.9%, p = 0.14), and 15 years (35.1% vs 31.0%, p = 0.12) was similar across cohorts.

Conclusions: A decreasing proportion of PHM undersized hearts are being utilized in obese recipients. However, utilizing PHM undersized hearts in obese recipients was not associated with a detriment in survival.
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http://dx.doi.org/10.1016/j.healun.2021.04.020DOI Listing
May 2021

FDA Advisory Committee favorably votes on OCS Heart.

Authors:
Jason J Han

Artif Organs 2021 Jun;45(6):544-545

The FDA Advisory Committee has recently voted favorably in support of the FDA approving the TransMedics OCS Heart device. If approved, the device could be used to improve donor heart viability and utilization in the United States.
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http://dx.doi.org/10.1111/aor.13966DOI Listing
June 2021

Looking Far and Close for the Solutions to Early Career Development.

Ann Thorac Surg 2021 May 19. Epub 2021 May 19.

Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA, 19104. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2021.04.086DOI Listing
May 2021

The impact of surgeon and hospital procedural volume on outcomes after aortic root replacement in the United States.

J Card Surg 2021 May 12. Epub 2021 May 12.

Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Objective: Surgeon procedural volume for complex cardiac procedures have become important quality metrics. The objective is to determine the association of surgeon and hospital case volume on patient outcomes after an aortic root replacement for aortic root aneurysms.

Methods: From 2009 to 2014, 4629 Medicare patients underwent an aortic root replacement for a root aneurysm. Procedures were performed by 1276 surgeons at 718 hospitals. Patients with endocarditis, aortic rupture, or Type-A dissection were excluded. Procedural volume was defined as mean number of cases performed each year during the study period. The impact of hospital and surgeon volume on adjusted 30-day mortality was analyzed as a continuous variable using adjusted logistic regression with cubic splines.

Results: After an aortic root replacement, we observed a nonlinear reduction in the adjusted odds ratio for 30-day mortality as surgeon and hospital volume increased. Surgeons that performed approximately five cases/year and hospitals that completed approximately five cases/year had the greatest reduction in the odds of perioperative death. Patients treated at high-volume hospitals (≥4.5 cases/year) had a lower risk for 30-day postoperative stroke (hazard ratio [HR] = 0.51, p = .008), myocardial infarction (HR = 0.49, p = .016), hemodialysis (HR = 0.44, p = .005), and reoperation (HR = 0.48, p = .003). Additionally, patients treated with high-volume surgeons (≥9 cases/year) had lower risk for stroke (HR = 0.65, p = .005), hemodialysis (HR = 0.65, p = .03), sepsis (HR = 0.62, p = .03), and reoperation (HR = 0.67, p = .004).

Conclusion: Among Medicare patients undergoing an aortic root replacement, there is a strong inverse relationship between annualized surgeon and hospital case volume and postoperative outcomes. Procedural volume is an important quality metric for this high-risk procedure.
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http://dx.doi.org/10.1111/jocs.15620DOI Listing
May 2021

From Individualism to Esprit de Corps.

Ann Thorac Surg 2021 May 8. Epub 2021 May 8.

Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2021.04.075DOI Listing
May 2021

Impact of Socioeconomic Status on Outcomes After Ventricular Assist Device Implantation Using the Area Deprivation Index.

J Card Fail 2021 May;27(5):597-601

Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

Background: This study evaluates the Area Deprivation Index (ADI) as a novel prognostic metric of socioeconomic status for patients with a left ventricular assist device.

Methods And Results: A retrospective analysis of patients with a left ventricular assist device at a high-volume institution from 2007 to 2018 was conducted. Socioeconomic status was determined using the ADI, a multifactorial neighborhood-based metric where higher ADI denotes worse socioeconomic status. Patients were stratified into 4 ADI cohorts. Long-term survival was compared with multivariate analysis. Of the 380 patients stratified by ADI, 35 were in the 10th percentile or lower, 218 were in the 11th-50th percentile, 104 were in the 51st-89th percentile, and 23 were in the 90th percentile or higher. Baseline characteristics were comparable. On multivariate analysis, being male (hazard ratio [HR], 0.14; P = .01), bridge-to-transplant (HR, 0.14; P = .03), and not requiring biventricular support (HR, 0.02; P < .01) were protective, whereas chronic kidney disease (HR, 9.07; P < .01) and an elevated total bilirubin (HR, 3.56; P = .02) were harmful. The ADI as a continuous variable did not affect survival; however, categorically, a higher ADI was protective (ADI 90-100: HR, 0.07; P = .04).

Conclusions: Socioeconomically disadvantaged patients had noninferior outcomes given appropriate pre-implant optimization and workup.
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http://dx.doi.org/10.1016/j.cardfail.2021.01.010DOI Listing
May 2021

Cardiac Surgery Simulation - Part II: Cannulation.

Multimed Man Cardiothorac Surg 2021 Apr 28;2021. Epub 2021 Apr 28.

Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America.

Our group has previously described how dedicated practice outside the operating room can improve surgical technique and enhance intraoperative performance. We have also recently developed a "do-it-yourself" simulator to practice a variety of operative scenarios in cardiac surgery. This video tutorial demonstrates our Cannulation Module, which is designed to hone skills in aortic, right atrial, left ventricular vent, and bicaval cannulation for cardiopulmonary bypass.
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http://dx.doi.org/10.1510/mmcts.2021.027DOI Listing
April 2021

Wisdom from Past Presidents of the Society of Thoracic Surgeons.

Ann Thorac Surg 2021 Apr 24. Epub 2021 Apr 24.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.

The Society of Thoracic Surgeons (STS) is a highly impactful professional organization in cardiothoracic surgery and an important network of mentors for trainees. Annually, STS presidents deliver an address encapsulating their professional experiences, lessons learned, and future vision for the field. We sought to summarize these lessons into salient points for trainees. Transcriptions from 1964 to 2018 were reviewed by residents and expounded into categories of importance for readers. Six overarching themes were identified which included: (1) leadership, (2) education, (3) clinical excellence and innovation, (4) humanism and professionalism, (5) diversity and inclusion, and (6) the future of cardiothoracic surgery.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.031DOI Listing
April 2021

Highlights from the 57th annual meeting of the Society of Thoracic Surgeons.

Artif Organs 2021 05;45(5):528-530

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

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http://dx.doi.org/10.1111/aor.13958DOI Listing
May 2021

Aeson-The Carmat total artificial heart is approved for enrollment in the United States.

Authors:
Jason J Han

Artif Organs 2021 May;45(5):445-446

Aeson, the Carmat Total Artificial Heart has been recently approved by the FDA for beginning enrollment in the United States. This follows their recent attainment of CE marking in 2020.
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http://dx.doi.org/10.1111/aor.13959DOI Listing
May 2021

Mitral and aortic valve surgery during left ventricular assist device implantation.

J Thorac Cardiovasc Surg 2021 Mar 18. Epub 2021 Mar 18.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.01.144DOI Listing
March 2021

Addressing Equity and More in 2021: Call From Fellows-in-Training & Early Career Section Editors.

J Am Coll Cardiol 2021 Mar;77(10):1372-1373

Division of Cardiovascular Medicine, Stanford University School of Medicine and VA Palo Alto Healthcare System, Palo Alto, California, USA.

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http://dx.doi.org/10.1016/j.jacc.2021.02.001DOI Listing
March 2021

Training the trainee in structural heart disease: A need for change.

J Thorac Cardiovasc Surg 2021 Feb 16. Epub 2021 Feb 16.

Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex.

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http://dx.doi.org/10.1016/j.jtcvs.2021.02.016DOI Listing
February 2021

Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes.

Eur J Cardiothorac Surg 2021 Feb 28. Epub 2021 Feb 28.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Objectives: Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited.

Methods: Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan-Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival.

Results: A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12-1.35), concomitant aortic (1.44; 1.10-1.90) and tricuspid valve procedures (2.21; 1.64-2.97) and prior history of myocardial infarction (1.48; 1.07-1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19-8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality.

Conclusions: Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.
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http://dx.doi.org/10.1093/ejcts/ezab091DOI Listing
February 2021

Finding alignment between numbers and values in medical education.

Med Educ 2021 05 11;55(5):553-555. Epub 2021 Mar 11.

Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA.

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http://dx.doi.org/10.1111/medu.14479DOI Listing
May 2021

Commentary: Surgery of hypertrophic cardiomyopathy: Focus really does matter.

J Thorac Cardiovasc Surg 2020 Sep 18. Epub 2020 Sep 18.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.09.065DOI Listing
September 2020

Characteristics and Attitudes of Aspiring Cardiothoracic Surgeons: A Survey Study.

Ann Thorac Surg 2021 Feb 4. Epub 2021 Feb 4.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

Background: Although recruiting highly qualified, diverse applicants into cardiothoracic surgery remains a national priority, their characteristics remain unknown. This study aims to describe current and future applicants in cardiothoracic surgery.

Methods: Aspiring cardiothoracic surgeons (students interested in matriculating in a North American training program) were voluntarily enrolled in the study through Twitter and email outreach. A 33-question survey evaluated their backgrounds, research experiences, attitudes, and interests within cardiothoracic surgery. Standard descriptive statistics were used.

Results: There were 111 participants, 40 of whom were female (36.0%) and 27 of whom identified as an underrepresented minority (24.3%). Of the total, 63 belonged to an institution with a cardiothoracic surgery training program (56.8%). A total of 91 students envisioned having a mostly operative career (82.0%) and 75 envisioned pursuing educational roles (67.6%). The most popular surgical specialties were heart transplantation (50.5%) and aortic surgery (47.8%). Participants selected having a high-intensity operative environment (81.2%) and an innovative academic environment (58.8%) as the most attractive qualities. Perceived lack of work-life balance (46%) and toxic training or work environment (28%) were the greatest deterrents. Finances during the application process were perceived as a potential barrier by 41 students (36.9%). Approximately 75% of students (83 of 111) had faculty as mentors; 46.8% (56 of 111) thought that cardiothoracic surgery faculty were approachable but had limited time for mentorship.

Conclusions: This survey study characterized a nationally selected pool of aspiring cardiothoracic surgeons using social media. Future studies involving larger and more diverse cohorts are warranted to find areas for improvement in recruitment, retention, and diversity.
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http://dx.doi.org/10.1016/j.athoracsur.2021.01.040DOI Listing
February 2021

How Should Physicians Manage Neuroprognosis with ECPR?

Narrat Inq Bioeth 2020 ;10(2):173-182

Rapidly advancing technologies in the field of extracorporeal cardiopulmonary resuscitation (ECPR) have presented a new challenge in accurate neuroprognostication following cardiac arrest. Determination of brain state informs the prognostic picture and allows providers to begin effective communication regarding likelihood of meaningful neurological recovery as defined by patients or family members. The evolving role of sedation during ECPR and its impacts on ethical tension in decision-making is reviewed. Work surrounding the advancing field of neuroprognostication after cardiac arrest and hypothermia is summarized and implications of premature withdrawal of life-sustaining treatments are discussed. Advances that improve predictive value for neurological recovery are utilized in affirming and discussing the implications for end-of-life wishes of individuals in the setting of intensive resuscitative therapies.
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http://dx.doi.org/10.1353/nib.2020.0046DOI Listing
January 2020

Cardiac surgery simulation - Part 1: Basic Surgical Skills.

Multimed Man Cardiothorac Surg 2020 Dec 21;2020. Epub 2020 Dec 21.

Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania United States of America.

Simulation and dedicated practice outside the operating room can improve surgical technique and enhance intraoperative learning and performance. We designed a "do-it-yourself" simulator for use at home made from inexpensive, readily accessible materials that faithfully recreates multiple operative scenarios in cardiac surgery. This video tutorial demonstrates how to build our modular cardiac surgery simulator and to practice drills using our Basic Surgical Skills Module, which helps hone basic linear suturing, needle angles, and knot tying.
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http://dx.doi.org/10.1510/mmcts.2020.073DOI Listing
December 2020

Establishing an Interdisciplinary Research Model Among Trainees: Preparing for a Heart Team Future.

J Am Coll Cardiol 2020 11;76(21):2565-2568

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jacc.2020.10.015DOI Listing
November 2020

Development and Evolution of the Thoracic Surgery Residents Association.

Ann Thorac Surg 2021 02 4;111(2):723-728. Epub 2020 Nov 4.

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

The Thoracic Surgery Residents Association (TSRA) was established in 1997 as a trainee-led organization under the guidance of the Thoracic Surgery Directors Association (TSDA) to represent the interests and meet the educational needs of cardiothoracic surgery residents across North America. Since its founding, the TSRA has continuously evolved and expanded to further its primary mission. In addition to now offering text- and audio-based educational resources, the TSRA acts to connect students, trainees, and faculty, with the ultimate goal of fostering relationships that will benefit not only individuals but also the field of cardiothoracic surgery as a whole.
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http://dx.doi.org/10.1016/j.athoracsur.2020.08.062DOI Listing
February 2021

The Thoracic Surgery Residents Association: Past contributions, current efforts, and future directions.

J Thorac Cardiovasc Surg 2020 Aug 31. Epub 2020 Aug 31.

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

Objective: The Thoracic Surgery Residents Association (TSRA) is a resident-led organization established in 1997 under the guidance of the Thoracic Surgery Directors Association to represent the interests and educational needs of cardiothoracic surgery residents. We aim to describe the past contributions, current efforts, and future directions of the TSRA within a conceptual framework of the TSRA mission.

Methods: Primary review of educational resources was performed to report goals and content of past contributions. TSRA Executive Committee input was used to describe current resources and activities, as well as the future goals of the TSRA. Podcast analytics were performed to report national and global usage.

Results: Since 2011, the TSRA has published 3 review textbooks, 5 reference guides, 3 test-preparation textbooks, 1 supplementary publication, and 1 multiple-choice question bank and mobile application, all written and developed by cardiothoracic surgery trainees. In total 108 podcasts have been recorded by mentored trainees, with more than 175,000 unique listens. Most recently, the TSRA has begun facilitating trainee submissions to Young Surgeon's Notes, fostered a trainee mentorship program, developed the monthly TSRA Newsletter, and established a wide-reaching presence on Facebook, Twitter, and Instagram to help disseminate educational resources and opportunities for trainees.

Conclusions: The TSRA continues to be the leading cardiothoracic surgery resident organization in North America, providing educational resources and networking opportunities for all trainees. Future directions include development of an integrated disease-based resource and continued collaboration within and beyond our specialty to enhance the educational opportunities and career development of cardiothoracic trainees.
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http://dx.doi.org/10.1016/j.jtcvs.2020.08.086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456949PMC
August 2020

Commentary: The stem cell bridge: Forging a path above cold storage.

J Thorac Cardiovasc Surg 2020 Sep 14. Epub 2020 Sep 14.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.09.038DOI Listing
September 2020

Mentorship Effectiveness in Cardiothoracic Surgical Training.

Ann Thorac Surg 2020 Oct 1. Epub 2020 Oct 1.

Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address:

Background: Mentoring is an essential component of cardiothoracic surgery training, yet trainees report varied experiences despite substantial efforts to enhance mentorship opportunities. This study aimed to evaluate mentorship effectiveness and identify gaps in mentorship education.

Methods: A survey was distributed to cardiothoracic surgical trainees in Accreditation Council for Graduate Medical Education-accredited programs (n = 531). Responses to 16 questions concerning trainee experiences, expectations, and perspectives on mentorship were collected. An 11-component mentorship effectiveness tool generated a composite score (0 to 55), with a score of 44 or lower indicating less effective mentorship.

Results: Sixty-seven residents completed the survey (12.6%), with most (83.6%) reporting a current mentor. Trainees with mentors cited "easy to work with and approachable" (44 of 58; 75.9%) as the major criterion for mentor selection, whereas trainees without a mentor reported an inability to identify one who truly reflected the resident's needs (6 of 11; 45.5%). Resident age, gender, race or ethnicity, marital status, family status, postgraduate year, and training program type or size were not associated with having a mentor (P = .15 to .73). The median mentorship effectiveness score was 51 (interquartile range, 44, 55). More than one-third of residents (25 of 67) had either no mentor (n = 6) or less effective mentorship (n = 16), or both (n = 3). Resident and program characteristics were not associated with mentorship effectiveness (P = .39 to .99). Finally, 61.2% of residents had not received education on effective mentorship, and 53.8% did not currently serve as a mentor.

Conclusions: Many resident respondents have either no mentor or less effective mentorship, and most reported not having received education on mentorship. Addressing these gaps in mentorship training and delivery should be prioritized.
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http://dx.doi.org/10.1016/j.athoracsur.2020.07.045DOI Listing
October 2020

Heart transplant waiting list implications of increased ventricular assist device use as a bridge strategy: A national analysis.

Artif Organs 2021 Apr 5;45(4):346-353. Epub 2021 Mar 5.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

The use of ventricular assist devices (VADs) as a bridge to heart transplant (HT) is increasing, while HT volume remains stagnant. This may portend longer waiting times and an otherwise more competitive environment for all patients on the HT waiting list. A retrospective analysis of patients who were listed for HT in the United Network for Organ Sharing (UNOS) database from 2000 to 2015 was conducted. Mean waiting time, proportion of HT reception (%HT), proportion of death (%death), and proportion of waiting list removal (%removal) were calculated across three eras: Era 1 (2000-2007), Era 2 (2008-2011), and Era 3 (2012-2015). During the study period, 29 728 patients successfully underwent HT. 19 127 (64.3%) were directly transplanted (direct HT); 4491 (15.1%) received VADs prior to listing as a bridge to decision (BTD); and 4593 (15.5%) received VADs after listing as a bridge to transplant (BTT). Across the three eras, the average number of registrants per year grew. Among all groups, waiting time increased across the eras. %HT generally decreased in the BTD and BTT groups but remained constant in the direct HT group. %removal increased, while %death decreased in all group across the eras. Waiting time for HT increased from 2000 to 2015. Patients with VADs as a bridge strategy experienced decreasing %HT and increasing %removal but stable survival. Improvements in VAD safety and durability will ensure their success as part of a bridge strategy to HT under the new UNOS allocation policy.
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http://dx.doi.org/10.1111/aor.13833DOI Listing
April 2021

Mitral Valve Surgery in Pulmonary Hypertension Patients: Is Minimally Invasive Surgery Safe?

Ann Thorac Surg 2021 Jun 28;111(6):2012-2019. Epub 2020 Sep 28.

Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

Background: Compared with conventional full sternotomy (FS) approaches, minimally invasive mitral valve surgery (MIMVS) offers improved cosmesis, decreased pain and bleeding, and faster recovery without compromising repair or survival rates. However, little is known about outcomes in patients with pulmonary hypertension (PH), an independent risk factor for morbidity and mortality.

Methods: Retrospective review was performed between 2002 and 2019 for all adult patients undergoing isolated mitral valve surgery. Patients with PH (mean pulmonary artery pressure ≥25 mm Hg) were stratified by FS or MIMVS, and nearest-neighbor propensity score matching was performed to adjust for differences in baseline characteristics.

Results: Overall, 591 operations (317 MIMVS, 274 FS) met inclusion criteria during the study period. Nearest-neighbor propensity matching generated 112 well-matched pairs. Cardiopulmonary bypass (137 vs 89.5 minutes, P < .001), cross-clamp (102 vs 63 minutes, P < .001), and total operative times (241 vs 178.5 minutes, P < .001) were longer for the MIMVS group. Postoperatively, MIMVS was associated with shorter initial ventilator times (6 vs 9.6 hours, P < .001) and hospital lengths of stay (7 vs 8 days, P = .049), as well as blood product usage rates (26.8% vs 41.1%, P = .03). Survival at 30 days (0.0% vs 2.7%, P = .12) and 10 years (log-rank, P = .661) were similar between groups.

Conclusions: MIMVS is safe in patients with PH and provides traditional benefits of minimally invasive surgery, including shorter initial ventilator times and hospital length of stay, without compromising on long-term survival.
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http://dx.doi.org/10.1016/j.athoracsur.2020.06.147DOI Listing
June 2021

Neighborhood socioeconomic status is associated with differences in operative management and long-term survival after coronary artery bypass grafting.

J Thorac Cardiovasc Surg 2020 Aug 19. Epub 2020 Aug 19.

Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa. Electronic address:

Objective: We sought to characterize differences in operative management and surgical outcomes after coronary artery bypass grafting associated with the socioeconomic context in which a patient lives.

Methods: We used a validated index of 17 variables derived from the US Census Bureau to assign socioeconomic status at the block group level to patients who underwent isolated coronary artery bypass grafting at a single institution over a 16-year period. Operative mortality, stroke, renal failure, prolonged ventilation, sternal wound infection, reoperation, composite morbidity or mortality, long-term survival, and use of arterial conduits were the outcomes assessed.

Results: This study was composed of 6751 patients. Lower socioeconomic status was significantly associated with increased rates of stroke, renal failure, prolonged ventilation, and composite morbidity or mortality in a multivariable analysis. Low socioeconomic status was significantly associated with poorer long-term adjusted survival (hazard ratio, 1.26; 95% confidence interval, 1.03-1.55). Finally, lower socioeconomic status was significantly associated with decreased use of more than 1 arterial conduits in a multivariable analysis.

Conclusions: The socioeconomic context in which a patient lives is significantly associated with short- and long-term outcomes after coronary artery bypass grafting. There may also be variation in operative management, demonstrated by decreased use of arterial conduits. Lower rates of arterial revascularization among socioeconomically disadvantaged patients who undergo coronary artery revascularization may provide a target for intervention.
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http://dx.doi.org/10.1016/j.jtcvs.2020.08.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959671PMC
August 2020

Ethical Dilemmas Associated With the COVID-19 Pandemic: Dealing With the Unknowns and Unanswerables During Training.

J Am Coll Cardiol 2020 Sep;76(10):1266-1269

Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jacc.2020.07.041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458529PMC
September 2020