Publications by authors named "Joseph DiNatale"

3 Publications

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Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass.

Ann Thorac Surg 2019 11 7;108(5):1307-1313. Epub 2019 Aug 7.

Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address:

Background: Elevated preoperative hemoglobin A (HbA) is a predictor of poor outcomes after coronary artery bypass grafting (CABG), but the role of postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with major adverse events (MAEs) after isolated CABG.

Methods: This retrospective study evaluated 2215 patients who underwent isolated CABG from January 2012 to March 2018 at 2 medical centers. Postoperative GV in the first 12 hours and 24 hours was measured by the SD, coefficient of variation, and mean amplitude of glycemic excursions. The primary outcome (MAEs) was the composite of postoperative cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and 30-day mortality. Multivariate logistic regression assessed the independent association of GV with MAE.

Results: A total of 2215 patients met the study criteria, and an MAE developed in 260 patients (11.7%). High 12-hour and 24-hour postoperative GV were associated with elevated HbA, insulin-dependent diabetes, renal failure, and nonelective operation. Multivariate logistic regression analysis showed MAEs were associated with increased mean postoperative glucose in the first 12 hours (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.008-1.018; P < .001), the first 24 hours (OR, 1.017; 95% CI, 1.010-1.024; P < .001), and 24-hour postoperative GV (OR, 1.22; 95% CI, 1.09-1.37; P < .001). MAEs were not associated with preoperative HbA or 12-hour postoperative GV.

Conclusions: Increased 24-hour but not 12-hour postoperative GV after CABG is a predictor of poor outcomes. Preoperative HbA is not associated with MAEs after adjusting for postoperative mean glucose and GV.
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http://dx.doi.org/10.1016/j.athoracsur.2019.06.046DOI Listing
November 2019

Increased glucose variability is associated with atrial fibrillation after coronary artery bypass.

J Card Surg 2019 Jul 17;34(7):549-554. Epub 2019 May 17.

Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Background: Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes following coronary artery bypass grafting (CABG), but the role of increased postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with an increased risk of postoperative atrial fibrillation following isolated CABG.

Methods: Multicenter retrospective study of 2073 patients who underwent isolated CABG from January 2012 to March 2018. Postoperative GV in the first 24 hours was measured by standard deviation, coefficient of variation, and mean amplitude of glycemic excursions. Multivariate logistic regression assessed the independent association of GV with postoperative atrial fibrillation.

Results: A total of 2073 patients met the study criteria, and 446 patients (21.5%) developed postoperative atrial fibrillation. Using multivariate logistic regression to adjust for covariates, postoperative atrial fibrillation was associated with increased 24-hour GV (odds ratio [OR] = 1.16, 95% confidence interval [CI], 1.05-1.27, P < 0.01) and increased 24-hour mean glucose (OR = 1.14, 95% CI, 1.08-1.21, P < 0.01). Thus, for every 10% increase in 24-hour GV or 10 mg/dL increase in mean glucose, there was a 16% or 14% increased risk of postoperative atrial fibrillation respectively.

Conclusions: Increased 24-hour GV and mean glucose are predictors of atrial fibrillation after CABG. Preoperative HbA1c is not a risk factor for postoperative atrial fibrillation after adjusting for postoperative mean glucose and GV. Further investigation is needed to determine the relationship between adherence to strict glucose control and adverse events following CABG.
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http://dx.doi.org/10.1111/jocs.14071DOI Listing
July 2019

Warm, beating heart aortic valve replacement in a sickle cell patient.

Interact Cardiovasc Thorac Surg 2010 Jan 6;10(1):67-8. Epub 2009 Oct 6.

Department of Cardiothoracic Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.

Patients with sickle cell abnormalities undergoing surgery are generally considered to be at greater risk for perioperative complications. We present a 25-year-old woman with sickle cell disease (SCD) and severe aortic insufficiency. A minimally invasive, warm, beating heart approach was adopted to try and minimize the risk of sickling due to cardiopulmonary bypass (CPB), low-flow states, cold cardioplegia and aortic cross-clamping. Compared to classical methods, we believe our technique further reduces the risk of systemic and organ hypothermia and thus, sickling.
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http://dx.doi.org/10.1510/icvts.2009.214395DOI Listing
January 2010
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