Publications by authors named "Stevan S Pupovac"

10 Publications

  • Page 1 of 1

Paucicellular Fibroma of the Ascending Aorta.

Aorta (Stamford) 2021 Oct 12. Epub 2021 Oct 12.

Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.

Primary tumors of the aorta are extremely rare. To the best of our knowledge, herein, we present the first case in the literature of a paucicellular fibroma originating from the aortic wall.
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http://dx.doi.org/10.1055/s-0041-1730006DOI Listing
October 2021

Moderate Versus Deep Hypothermia in Type A Acute Aortic Dissection Repair: Insights from the International Registry of Acute Aortic Dissection.

Ann Thorac Surg 2021 Jan 28. Epub 2021 Jan 28.

Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.

Background: The optimal strategy for cerebral protection during repair of type A acute aortic dissection has yet to be determined. We sought to determine the impact of differing degrees of hypothermia in patients undergoing acute dissection repair.

Methods: All patients in the International Registry of Acute Aortic Dissection Interventional Cohort database who underwent type A acute aortic dissection repair between 2010 and 2018 were identified. Data for operative temperature were available for 1962 patients subsequently divided into 2 groups according to lowest temperature: moderate hypothermic circulatory arrest (MHCA) (20-28°C) versus deep hypothermic circulatory arrest (DHCA) (<20°C). We then propensity matched 362 pairs of patients and analyzed operative data and short-term outcomes.

Results: The median lowest temperature was 25.0°C in the matched MHCA group as compared with 18.0°C in the DHCA group. For the entire cohort of 1962 patients, in-hospital mortality was 14.2% (278 deaths) but was not significantly different between DHCA and MHCA. The perioperative stroke rate was comparable between groups, before and after propensity matching. Circulatory arrest times were significantly longer in the MHCA cohort, regardless of matching. Use of antegrade or retrograde cerebral perfusion was similar in matched groups. There were no differences in 30-day survival or in other major postoperative morbidity between the 2 matched cohorts.

Conclusions: A surgical strategy of MHCA + antegrade cerebral perfusion is at least as safe as DHCA during repair of acute type A aortic dissection.
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http://dx.doi.org/10.1016/j.athoracsur.2021.01.027DOI Listing
January 2021

Impact That Day of the Week has on Length of Stay for Video-assisted Lobectomy.

Semin Thorac Cardiovasc Surg 2021 Autumn;33(3):897-901. Epub 2020 Nov 23.

Department of Cardiovascular and Thoracic Surgery, Division of Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York.

We aimed to analyze the effect that the day of the week for video-assisted thoracoscopic surgery lobectomy has on length of stay . A retrospective review identified all patients who underwent video-assisted thoracoscopic surgery lobectomy at a single institution from January 2016 to July 2017. In total, 208 patients were divided into 2 groups based on timing of their operation: Operations performed on Monday, Tuesday, or Wednesday were defined as "early in the week" and those performed on Thursday or Friday were defined as "late in the week." We then propensity-matched 81 pairs of patients and analyzed perioperative data and short-term clinical outcomes. A total of 208 patients underwent video-assisted thoracic surgery lobectomy during the study period. Length of stay was significantly decreased by 2.0 days (P <0.0001) for all lobectomies performed "early in the week" compared with those performed "late in the week." Thirty-day mortality and all major morbidities did not significantly different between the 2 matched groups. Our findings suggest that major pulmonary resections should be performed early in the week, when feasible, to facilitate utilization of hospital resources and prompt discharge.
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http://dx.doi.org/10.1053/j.semtcvs.2020.11.023DOI Listing
November 2020

Degenerative Pulmonary Valve Insufficiency in a Patient With a Prior Bentall Procedure.

Ann Thorac Surg 2021 05 8;111(5):e333-e334. Epub 2020 Oct 8.

Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York.

Adult pulmonary valve regurgitation most commonly presents after congenital cardiac surgery, with limited reports of pure degenerative valvular disease. We present a patient who underwent a Bentall procedure for annuloaortic ectasia with severe aortic insufficiency 14 years prior now presenting with degenerative, severe, symptomatic pulmonary valve regurgitation and normal pulmonary pressures. The patient underwent successful valve replacement with a bovine prosthesis. Recovery was unremarkable, and he continues to do well without further cardiac surgical requirements.
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http://dx.doi.org/10.1016/j.athoracsur.2020.07.058DOI Listing
May 2021

Intermediate oncologic outcomes after uniportal video-assisted thoracoscopic thymectomy for early-stage thymoma.

J Thorac Dis 2020 Aug;12(8):4025-4032

Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA.

Background: Recent years have seen a trend towards utilizing a video-assisted thoracic surgery (VATS) approach for treatment of thymoma. Although increasing in practice, intermediate- and long-term oncologic outcome data is lacking for the VATS approach. There is no oncologic data for the uniportal VATS approach. We sought to evaluate the feasibility and impact on patient survival of uniportal VATS thymectomy for early-stage thymoma.

Method: The clinical outcomes for 17 patients with Masaoka stage I to II thymomas treated between January of 2009 and July of 2014 at a single institution were collected retrospectively. Primary endpoint was overall survival (OS) and secondary endpoint was recurrence-free survival (RFS).

Results: Ten women and seven men underwent uniportal VATS thymectomy; eleven had stage I thymoma and six had stage II thymoma. There were no conversions to open surgery. Operative mortality was zero. Mean tumor size was 3.8±1.0 centimeters, with a range of 1.9 to 6.0 centimeters. All patients underwent a R0 resection. Five-year survival was 100%, and the estimated RFS was 100%.

Conclusions: Our findings suggest that uniportal VATS thymectomy for early-stage thymoma is feasible, and the intermediate-term oncologic outcomes are comparable to historic standards for open and multi-incision VATS thymectomy. However, additional follow-up is required to evaluate for long-term oncologic outcomes.
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http://dx.doi.org/10.21037/jtd-20-1370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475555PMC
August 2020

Robotic-Assisted First Rib Resection: Our Experience and Review of the Literature.

Semin Thorac Cardiovasc Surg 2020 Winter;32(4):1115-1120. Epub 2020 May 21.

Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, New York.

Thoracic outlet syndrome (TOS) comprises a constellation of signs and symptoms that arise from neurologic and vascular compression of the brachial plexus and subclavian vasculature, respectively. Surgical decompression of the neurovascular structures is often indicated to alleviate TOS. We report here our robotic surgical approach and experience for resection of the first rib. Between July 2014 and January 2017, 17 patients who underwent robotic-assisted first rib resection at our institution were reviewed. Nine women and 8 men with a mean age of 45 ± 11 years had a robotic-assisted first rib resection; 8 for neurogenic TOS and 9 for venous TOS. There were no complications or conversion to open surgery. The mean operative time was 113.2 ± 55.3 minutes. Length of stay was a mean of 1.8 ± 1.9 days. Length of rib resected was 5.8 ± 0.5 cm. Anticoagulation for the venous TOS cohort was Xarelto, for a mean of 5.1 ± 1.8 months. Short-term follow-up (mean 10.3 ± 4.9 days) revealed resolution of symptoms in all patients, with patent vasculature on venogram for the entire venous TOS cohort. Further follow-up at 2 months and 6 months revealed that all patients remained symptom free. Based on our institution's experience with the robotic-assisted approach to first rib resection, we feel that it is a feasible approach that could be added to the armamentarium of the thoracic surgeon.
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http://dx.doi.org/10.1053/j.semtcvs.2020.04.016DOI Listing
April 2021

Acute Type A Aortic Dissection Repair After Hours: Does It Influence Outcomes?

Ann Thorac Surg 2020 11 28;110(5):1622-1628. Epub 2020 Mar 28.

Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.

Background: Time of day has been associated with adverse outcomes in certain surgical pathologies. Because acute type A aortic dissection typically mandates immediate repair, relatively little attention has been paid to the potential impact of the day-night timing of the operation itself. We sought to determine whether patients with acute dissection treated during typical working hours demonstrated a difference in outcomes compared with those who required surgery after hours.

Methods: We undertook a comprehensive review of our prospectively collected database from July 2014 to October 2018. A total of 164 consecutive patients underwent primary repair of an acute type A dissection. Based on the procedure start time, patients were divided into 2 groups: working hours (7 am to 4 pm, Monday to Friday; n = 60), and after hours (all other times, including weekends and holidays; n = 104). We propensity-matched 58 pairs of patients and analyzed perioperative data and short-term clinical outcomes.

Results: Thirty-day mortality for all 164 patients was 10.4% (17 deaths), which was not significantly different between the matched groups (working-hours: 8 deaths [13.8%] versus after hours: 4 deaths [6.9%]; P = .36). Perfusion, cross-clamp, and circulatory arrest times did not differ between groups, nor did the types of aortic repairs performed. Postoperative complications were also comparable, including stroke, reoperation for bleeding, and new-onset renal failure requiring dialysis.

Conclusions: Thirty-day mortality and major morbidity after acute type A dissection repair are independent of when the operation is performed. Expeditious surgical intervention is recommended for all primary acute type A dissection, irrespective of time of day.
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http://dx.doi.org/10.1016/j.athoracsur.2020.02.048DOI Listing
November 2020

Prosthetic Valve Legionella Endocarditis.

Ann Thorac Surg 2019 10 14;108(4):e271-e272. Epub 2019 Mar 14.

Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York.

This report describes the case of an 80-year-old man with culture-negative prosthetic valve endocarditis who ultimately was given a diagnosis of Legionella pneumophila endocarditis.
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http://dx.doi.org/10.1016/j.athoracsur.2019.02.006DOI Listing
October 2019

Benefits of Electromagnetic Navigational Bronchoscopy for Identifying Pulmonary Nodules for Robotic Resections.

Innovations (Phila) 2017 Nov/Dec;12(6):418-420

Objective: The ability to localize pulmonary nodules via the robotic thoracic technique can be challenging at times. This is most evident when nodules are small and/or ground glass in nature. Information regarding methods available to localize these difficult nodules, while maintaining a minimally invasive robotic approach, is limited.

Methods: We describe a diagnostic and therapeutic method of combining electromagnetic navigational bronchoscopy with a total minimally invasive robotic approach that identifies these difficult-to-localize pulmonary nodules. The technique entails the use of electromagnetic navigational bronchoscopy to place a pleural dye marker with a subsequent pulmonary resection via a robotic thoracic approach.

Results: A cohort of 15 patients from August 2014 to December 2015 was reviewed. These patients underwent the combined approach of electromagnetic navigational bronchoscopy followed by a robotic pulmonary resection. Fourteen of the 15 patients had a successful combined procedure, which was confirmed with pathology. The range of the nodules was 0.8 to 2 cm. Methylene blue was used for pleural dye marking. On one occasion, the pleural dye was not able to be deciphered. There were no complications from either the electromagnetic navigational bronchoscopy or robotic portions of the procedure.

Conclusions: Pleural dye marking via electromagnetic navigational bronchoscopy can provide an effective method for localizing pulmonary nodules, while maintaining a minimally invasive robotic approach. This tactic allows one to obtain diagnostic tissue more efficiently, while limiting the potential inability to localize a nodule.
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http://dx.doi.org/10.1097/IMI.0000000000000440DOI Listing
August 2018

Spontaneous pneumomediastinum: an extensive workup is not required.

J Am Coll Surg 2014 Oct 6;219(4):713-7. Epub 2014 Jun 6.

Department of Surgery, Section of Thoracic Surgery, Albany Medical Center, Albany, NY.

Background: Spontaneous pneumomediastinum is a rare entity usually caused by alveolar rupture and air tracking along the tracheobronchial tree. Despite its benign nature, an extensive workup is often undertaken to exclude hollow viscus perforation. We sought to review our experience with this condition and examine the optimal management strategy.

Study Design: We conducted a retrospective review of all radiographic pneumomediastinum cases at a tertiary hospital between 2006 and 2011. The main outcomes measures included length of hospital stay, mortality, and need for investigative procedures.

Results: Forty-nine patients with spontaneous pneumomediastinum were identified, including 26 male patients (53%). Mean age was 19 ± 9 years. Chest pain was the most common presenting symptom (65%), followed by dyspnea (51%). Forceful coughing (29%) or vomiting (16%) were the most common eliciting factors, and no precipitating event was identified in 41% of patients. Computed tomography was performed in 38 patients (78%) and showed a pneumomediastinum that was not seen on chest x-ray in 9 patients. Esophagography was performed in 17 patients (35%) and was invariably negative for a leak. Thirty-eight patients (78%) were hospitalized for a mean of 1.8 ± 2.6 days. No mortality was recorded. Compared with patients who presented with pneumomediastinum secondary to esophageal perforation, spontaneous pneumomediastinum patients were younger, had a lower white cell count, and were less likely to have a pleural effusion.

Conclusions: Spontaneous pneumomediastinum is a benign entity and rarely correlates with true esophageal perforation. Additional investigation with esophagography or other invasive procedures should be performed selectively with the aim of expediting the patient's care. The prognosis is excellent with conservative management and the risk for recurrence is low.
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http://dx.doi.org/10.1016/j.jamcollsurg.2014.06.001DOI Listing
October 2014
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