Publications by authors named "Wilson Ko"

36 Publications

Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth.

Am J Prev Med 2018 09 19;55(3):361-367. Epub 2018 Jul 19.

National Institute on Minority Health and Health Disparities Division of Intramural Research, Bethesda, Maryland.

Introduction: The purpose of this study is to examine adolescent perceptions of harms and benefits associated with electronic cigarettes (e-cigarettes) and their associations with use.

Methods: Data from the 2016 Florida Youth Tobacco Survey were analyzed in 2017. Participants who were in high school aged 14-17 years were included (n=22,884). Logistic regression analyses were used to compare e-cigarette use groups on perceived harms and benefits of e-cigarettes.

Results: Less than one half of the sample reported that e-cigarettes are harmful to their health and less than two thirds reported that individuals can get addicted to e-cigarettes. Compared with committed never users, susceptible never users and all e-cigarette use groups were less likely to report that e-cigarettes were harmful to their health, people can get addicted to e-cigarettes, and that smoke from others' e-cigarettes were harmful. Furthermore, susceptible never users and all use groups were more likely to report that it would be easy to quit using e-cigarettes than committed never users. Susceptible never users and all use groups were also more likely to perceive benefits of e-cigarette use including having more friends, looking cool or fitting in, feeling more comfortable in social situations, and stress relief compared with committed never users.

Conclusions: Youth who are susceptible to use, currently use, or have used e-cigarettes are less likely to report harms and more likely to perceive benefits associated with e-cigarette use compared with committed never users. Addressing harm and benefit perceptions may be important for interventions designed to reduce e-cigarette use among adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2018.04.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168072PMC
September 2018

Optimal conduit for diabetic patients: propensity analysis of radial and right internal thoracic arteries.

Ann Thorac Surg 2014 Jul 28;98(1):30-6; discussion 36-7. Epub 2014 May 28.

Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.

Background: Multiple arterial grafts, in addition to the left internal thoracic artery, improve long-term survival after coronary artery bypass grafting (CABG); yet, the use of this procedure remains low for both the right internal thoracic artery (RITA) and the radial artery (RA). To identify the optimal arterial conduit to deploy for revascularization of diabetic patients, we compared the outcomes for RA and RITA grafts to the circumflex coronary.

Methods: From January 1, 1995, to December 31, 2011, 908 consecutive diabetic patients underwent first-time, isolated CABG (99% on-pump), 659 with the RA and 502 with the RITA, respectively, in two affiliated hospitals. Data were prospectively collected, and late mortality was determined from the Social Security Death Index. Propensity matching, based on preoperative and operative variables, identified 202 matched pairs from each group.

Results: Long-term survival was similar for matched patients. Mortality, myocardial infarction, reoperation for bleeding, stroke, sepsis, and renal failure were not significantly different between groups. However, deep sternal wound infection (p<0.035) and respiratory failure (p<0.048) favored the RA group, in which the total major adverse events were significantly fewer (p=0.002).

Conclusions: In diabetic patients undergoing multivessel revascularization with either RA or RITA grafts to the circumflex coronary, long-term survival is similar. However, RA patients experienced significantly fewer respiratory or sternal wound adverse events. The RA is the preferred conduit to extend to more diabetic patients the recognized survival benefit of a multiple arterial graft strategy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2014.03.044DOI Listing
July 2014

Progressive dyspnea in patient with large mediastinal mass.

J Cardiothorac Surg 2014 Jan 6;9. Epub 2014 Jan 6.

Division of Cardiac Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA.

Liposarcoma occurs very rarely in the mediastinum. Patients often remain asymptomatic until it grows large enough to cause direct invasion or compression of adjacent organs. We report a case of a 77-year-old male presented with dyspnea of exertion and was found to have a large mediastinal mass which was eventually diagnosed as primary mediastinal well-differentiated liposarcoma. The limited respiratory function at the initial presentation prompted phrenic nerve preserving incomplete resection rather than radical removal of the adjacent mediastinal structures. After surgical removal, the recurrence for well-differentiated mediastinal liposarcomas in the mediastinum is unknown; therefore, close follow-up is crucial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1749-8090-9-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896736PMC
January 2014

Time-varying survival benefit of radial artery versus vein grafting: a multiinstitutional analysis.

Ann Thorac Surg 2014 Apr 17;97(4):1328-34; discussion 1334. Epub 2013 Dec 17.

Department of Internal Medicine and Outcomes Research Unit, American University of Beirut, Beirut, Lebanon. Electronic address:

Background: A survival benefit of radial artery use versus saphenous vein grafting in coronary artery bypass grafting (CABG) has been reported. We aimed to elucidate the relative radial artery survival benefit as a function of time after surgery from two independent CABG series.

Methods: We compared 0- to 15-year survival with radial artery versus saphenous vein grafting in isolated, nonsalvage primary CABG with left internal thoracic artery to left anterior descending from two institutions: Ohio (radial artery [n=2,361; 61 years]; saphenous vein [n=2,547; 67 years]), and New York (radial artery [n=1,970; 58 years]; saphenous vein [n=2,974; 69 years]). Separate multivariate radial artery-use propensity models based on demographic, preoperative factors, intraoperative variables, and completeness of revascularization data were computed and used to derive propensity- and sex-matched CABG cohorts (1,799 [Ohio] and 995 [New York] pairs). A three-phase (early and late) mortality model was fit to Kaplan-Meier mortality estimates and used to derive relative radial artery versus saphenous vein hazard functions.

Results: Radial artery use patterns and patient risk profiles differed substantially for New York and Ohio, with the New York radial artery cohort significantly younger and more male. Within-institution matched graft-type cohorts were well matched. Cumulative mortality was significantly better for radial artery at both institutions (p < 0.001 both). All mortality-time data were well described by the three-phase model, and the derived relative hazard functions were qualitatively and quantitatively similar for New York and Ohio, exhibiting maximal benefit between 0.5 and 5 years.

Conclusions: Despite substantial differences in radial artery use patterns during a 15-year period, our analysis in large propensity-matched radial artery and saphenous vein cohorts yielded remarkably similar, time-varying radial artery to saphenous vein survival benefit at both institutions. These converging findings based on two independent patient series extend currently available objective evidence in support of a radial artery survival advantage in CABG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2013.09.096DOI Listing
April 2014

The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery.

J Thorac Cardiovasc Surg 2014 Jan 5;147(1):133-40. Epub 2013 Oct 5.

Division of Cardiothoracic Surgery, St. Luke's Roosevelt Hospital Center, New York, NY.

Objective: We sought to determine if the radial artery (RA) or the free right internal thoracic artery (RITA) is the better conduit to bypass the circumflex coronary artery during coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA).

Methods: Propensity matching was performed on 2488 CABG-LITA patients from 2 affiliated centers, resulting in 528 pairs who received either a RA at one center or a free RITA at the other center to bypass the circumflex coronary artery from 1995 to 2009.

Results: Kaplan Meier estimated 1-, 5-, 10-, and 15-year survival rates were 99%, 95%, 85%, and 76% for RA patients, respectively, and 97%, 92%, 80%, and 71% for RITA patients, respectively (P = .060). Major adverse events (MAEs) were fewer in the RA group (7.6% vs 14.0%; P = .001) and use of the RA was a significant predictor of reduced MAEs (odds ratio [OR], 0.48; P = .002) in all patients and especially in diabetic (OR, 0.32; P = .003), older (OR, 0.40; P = .009), obese (OR, 0.15; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 0.05; P = .016) patients. However, survival was better with RA only in COPD (hazard ratio, 0.49; P = .045) and older (hazard ratio, 0.71; P = .050) patients. Overall RA patency (83.9%) was similar to RITA patency (87.4%) at a mean of 5.1 ± 3.8 years (P = .155).

Conclusions: Long-term survival is similar in CABG-LITA patients using either a RA or free RITA graft to bypass the circumflex coronary artery. RA grafting has fewer MAEs, a similar patency to RITA, and improves survival in older and COPD patients. The choice of the second arterial conduit should be guided by patient profiles and surgeon preferences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2013.08.040DOI Listing
January 2014

Off-pump versus on-pump coronary artery bypass grafting in octogenarians: comparison of short-term outcomes and long-term survival.

Cardiology 2013 7;125(3):164-9. Epub 2013 Jun 7.

Division of Cardiothoracic Surgery, Downstate Medical Center, State University of New York, New York, N.Y., USA.

Off-pump coronary artery bypass (OPCAB) has gained increasing acceptance with potential benefits for high-risk elderly patients. We report a surgeon's operative outcomes in octogenarians with an OPCAB program. Retrospective, intention-to-treat analysis of 97 consecutive octogenarians who underwent coronary bypass by a single surgeon between 1997 and 2001 before and after initiation of a multi-vessel OPCAB program was performed. OPCAB was attempted in all octogenarians. The OPCAB cohort had higher serum creatinine (OPCAB vs. pre-OPCAB: 1.30 ± 0.79 mg/dl vs. 1.08 ± 0.27, p = 0.04) and ejection fractions (52 ± 14% vs. 45 ± 11%, p = 0.02) than the pre-OPCAB cohort. The OPCAB group was more likely to require urgent/emergency surgery (63 vs. 40%, p = 0.04) and to have chronic renal insufficiency (18 vs. 3%, p = 0.05). After programmatic change to OPCAB, significant postoperative improvements were observed in the length of hospital stay (17 ± 19 vs. 8 ± 4 days, p < 0.01), duration of inotropic requirement (47 ± 70 vs. 18 ± 39 h, p < 0.04), duration of ventilator support (51 ± 54 vs. 16 ± 27 h, p < 0.01) and incidence of tracheostomy (16 vs. 3%, p < 0.02). In-hospital mortalities (3.2 vs. 2.7%), strokes (3 per group) and 5-year survival did not differ significantly (57 vs. 67%, p = 0.50, NS). Despite some higher preoperative risks, the OPCAB program demonstrated clinical benefits in octogenarians but no advantage in hospital-mortality or long-term survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000350669DOI Listing
March 2014

Left atrial dissection: etiology and treatment.

Ann Thorac Surg 2013 May 28;95(5):1557-62. Epub 2013 Feb 28.

Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY 10003, USA.

Background: Left atrial dissection (LatD) is a rare entity most commonly associated with mitral valve surgery. We have reviewed our experience with 4 patients to better define the etiology and the treatment of LatD.

Methods: From 1991 to 2012, 4 patients experienced LatD after surgery (1 of 6,302, or 0.02%, of isolated coronary artery bypass grafting patients and 3 of 1,895, or 0.16%, of mitral valve patients). Patient and perioperative data and management were reviewed.

Results: Two patients were women, and ages ranged from 49 to 80 years. Three patients underwent mitral procedures (two replacements with coronary artery bypass grafting and one repair) for mitral regurgitation. One patient underwent emergent isolated coronary artery bypass grafting after cardiopulmonary resuscitation for a left main dissection during percutaneous coronary intervention. Three LatDs were found during surgery, and one LatD was found 12 days after mitral repair and was successfully treated nonoperatively. The LatD was located along the posterior atrial wall originating from the atrioventricular junction in all cases and obstructed mitral valve inflow. Operative repair focused on the evacuation of hematoma, obliteration of the false lumen, and repair of the entry injury. No mortality occurred.

Conclusions: Left atrial dissection is a rare complication of cardiac surgery, probably related to a contained atrioventricular separation allowing pressurized blood to separate the layers of the posterior left atrium. Prompt intraoperative diagnosis, obliterating the false cavity, and addressing the entry point are essential. In contrast, a nonoperative approach in a stable patient with a delayed LatD suggests healing of the dissection, and atrial remodeling occurs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2012.12.041DOI Listing
May 2013

Improving long term outcome for diabetic patients undergoing surgical revascularization by use of the radial artery conduit: a propensity matched study.

J Cardiothorac Surg 2013 Feb 19;8:27. Epub 2013 Feb 19.

Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, NY 10003, USA.

Background: Diabetes predicts worse outcomes after coronary artery bypass grafting (CABG) We hypothesized that a strategy using radial artery (RA) conduit(s) would improve outcomes and long term survival for diabetic patients undergoing CABG with Left Internal Thoracic Artery (LITA) and RA grafts, with or without additional saphenous vein (SV) when compared with outcomes for patients bypassed with LITA and SV but no RA.

Methods: A propensity matched study of long term survival in diabetic patients who had isolated first time CABG from January 1995 to June 2010 at an urban academic medical center in New York City. Our primary endpoint was all cause mortality determined from the Social Security Death Index in December 2010.

Results: We compared our 15 year outcomes in diabetic patients after isolated, primary CABG: 642 patients received LITA + RA +/- SV (RA group) vs. 1201 patients who had LITA + SV only (SV group). Propensity scoring for multiple preoperative and operative variables matched 409 patients from each group: 68% were male with an average age of 61 years and ejection fraction averaged 47%. Average grafts per patient was 3.7 for both groups with 2.3 arterial grafts per patient for the RA group. Operative (30 day) mortality was 0.1% RA vs. 1.9% SV, (p<0.0001) For propensity matched patients, mortality was 0.25 RA vs 0.5% SV. (p<0.001) The incidence of major complications was similar in both groups. Kaplan Meier actuarial survival at 1, 5, 10 and 12 years was 98%, 89%, 77 and 70% for RA vs. 96%, 87%, 64% and 59% for SV (p<0.006.) By Cox multivariate analysis significant predictors of mortality were: age, stroke, peripheral vascular disease, COPD, creatinine > 2.5mg/dl and low ejection fraction but only RA use predicted better survival [HR 0.683, CI 0.507- 0.920, p=0.0122].

Conclusion: For diabetic patients having CABG with LITA, use of radial artery conduit adds a substantial and sustained survival advantage compared to LITA and vein. Optimal revascularization for diabetics with multi vessel disease is redefined.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1749-8090-8-27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598974PMC
February 2013

Myocardial Revascularization in New York State: Variations in the PCI-to-CABG Ratio and Their Implications.

J Am Heart Assoc 2012 Apr 24;1(2):e001446. Epub 2012 Apr 24.

Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY (W.K., R.T.) ; New York Medical College, Vahalla, NY (W.K.).

Background: During the past 2 decades, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among hospitals and regions.

Methods And Results: We reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 through 2008 to define trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of the State. During this 15-year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries, and for PCI for New York State were -40%, -20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were similar as follows: -61%, -23%, +14%, and +284%. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; however, in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher than the ratios for New York City programs outside Manhattan, in Long Island, in the northern counties contiguous to New York City, and in the rest of New York State; their averages were 5.84, 5.38, 3.31, and 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared with the rest of New York State; in one Manhattan program, the likelihood was 215% higher.

Conclusions: There are substantial regional and statewide differences in the utilization of PCI versus CABG among cardiac centers in New York, possibly related to patient characteristics, physician biases, and hospital culture. Understanding these disparities may facilitate the selection of the most appropriate, effective, and evidence-based revascularization strategy. (J Am Heart Assoc. 2012;1:e001446 doi: 10.1161/JAHA.112.001446.).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.112.001446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487374PMC
April 2012

Radial artery grafting in women improves 15-year survival.

J Thorac Cardiovasc Surg 2013 Dec 2;146(6):1467-73. Epub 2012 Nov 2.

Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY. Electronic address:

Objectives: Radial artery (RA) grafting has a clear survival advantage after coronary artery bypass grafting (CABG) in studies with predominantly male populations, but the impact on women's long-term survival is unclear. We sought to determine if the reported long-term survival benefit of RA versus saphenous vein (SV) grafting in the general CABG population is valid for women.

Methods: Between 1995 and 2010, 1339 female patients were alive 30 days after primary, isolated CABG with left internal thoracic artery (LITA) and additional RA or SV conduits as needed. Patients were evaluated based on RA use: 332 patients had RA and 1007 patients had SV. Of these, 283 RA patients were matched to SV counterparts using a nonparsimonious propensity model based on 45 patient variables.

Results: Kaplan-Meier estimated survivals for the matched RA women at 1, 5, 10, and 15 years were 99%, 93%, 80%, and 70% versus 97%, 87%, 72%, and 58% for the SV women (log rank, P = .018). For symptomatic patients, overall RA patency was 80%, which was not different from the LITA patency rate of 84% but was superior to the SV conduits patency rate of 56% (P < .001).

Conclusions: In women undergoing CABG with LITA grafting, use of an RA graft improves survival compared with use of an SV graft.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2012.10.004DOI Listing
December 2013

Coronary artery bypass grafting using the radial artery: clinical outcomes, patency, and need for reintervention.

Circulation 2012 Sep;126(11 Suppl 1):S170-5

Division of Cardiac Surgery, Beth Israel Medical Center, First Ave at 16 St, New York, NY 10003, USA.

Background: Radial artery (RA) grafts are an attractive second arterial conduit after the left internal thoracic artery (LITA) for coronary artery bypass graft (CABG) surgery. However, long-term outcomes and the need for subsequent reintervention have not been defined.

Methods And Results: We performed a retrospective cohort study of our single institution's 16-year experience with 1851 consecutive patients (average age, 58 years; 82% men, 36% diabetic) undergoing primary, isolated CABG with the LITA, RA, and saphenous vein as needed. Average grafts per patient were 3.8, with 2.4 arterial grafts per patient. Survival was determined using the Social Security Death Index. Grafts were nonpatent if they had a >50% stenosis, a string sign, or were occluded. Five patients (0.3%) died in hospital and 0.8% had a myocardial infarction, 1.1% a stroke, and 0.6% renal failure. Kaplan-Meier-estimated 1-, 5-, 10-, and 15-year survival was 99%, 96%, 89%, and 75%, respectively. Of the cohort, 278 symptomatic patients underwent cardiac catheterization at our institution an average of 5.0±3.8 years (range, 0.1-12 years) after CABG. Overall RA (n=420 grafts) patency was 82% and SV (n=364 grafts) patency, 47% (P<0.0001). LITA (n=287 grafts including 9 sequential grafts) patency was 85% and right internal thoracic artery (n=15 grafts) patency was 80% (P=0.6). RA patency was not different from LITA patency (P=0.3). Overall freedom from catheterization, percutaneous coronary intervention, and CABG was 85%, 97%, and 99%, respectively.

Conclusions: RA grafting is a highly effective revascularization strategy providing excellent short and long-term outcomes with very low rates of reintervention. RA patency is similar to LITA patency and is much better than SV patency. RA grafting should be more widely utilized in patients undergoing CABG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.111.083048DOI Listing
September 2012

Arterial grafts protect the native coronary vessels from atherosclerotic disease progression.

Ann Thorac Surg 2012 Aug 22;94(2):475-81. Epub 2012 Jun 22.

Division of Cardiac Surgery, Beth Israel Medical Center, New York, New York 10003, USA.

Background: We sought to examine the effect of different conduits on the progression of atherosclerosis in previously revascularized coronary territories.

Methods: Between 1995 and 2010, 4,960 patients were discharged alive after primary isolated coronary artery bypass grafting (CABG) with a left internal thoracic artery (LITA) conduit and additional conduits as needed: radial artery (RA) or saphenous vein graft (SVG), or both. Seven hundred seventy-two patients had coronary angiography for recurrent symptoms an average of 5.5±3.5 years after CABG (range, 0.1-16 years). Cumulative graft patency and disease progression in the native vessels was estimated by the Kaplan-Meier survival method. The log-rank test was used to assess differences of disease progression per territory between different types of conduits.

Results: Kaplan-Meier-estimated 1-, 5-, and 10-year overall disease progression in territories with patent LITAs was 0.01%, 4%, and 8%, respectively; with patent RA grafts, it was 0.01%, 6%, and 11%, respectively (log-rank test, p=0.157); and with patent SVGs it was 3%, 19%, and 43%, respectively (log-rank test; p<0.0001). Disease progression in grafted native coronary arteries in the anterior territory with patent LITA-to-left anterior descending (LAD) artery was 8%, and with patent RA grafts versus patent SVGs to the diagonal branches of LAD artery was 10% and 40%, respectively (log-rank test; p<0.0001). Disease progression in grafted native coronary arteries to the lateral territory with a patent RA graft was 11% versus 50% with a patent SVG (log-rank test; p<0.0001).

Conclusions: RA and LITA grafting has a strong protective effect against progression of native coronary artery disease in previously grafted vessels. Multiple arterial grafting may improve long-term survival by preventing progression of atherosclerosis in the native coronary vessels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2012.04.035DOI Listing
August 2012

MASP-2 activation is involved in ischemia-related necrotic myocardial injury in humans.

Int J Cardiol 2013 Jun 15;166(2):499-504. Epub 2011 Dec 15.

Department of Anesthesiology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.

Background/objectives: Insufficient blood supply to the heart results in ischemic injury manifested clinically as myocardial infarction (MI). Following ischemia, inflammation is provoked and related to the clinical outcomes. A recent basic science study indicates that complement factor MASP-2 plays an important role in animal models of ischemia/reperfusion injury. We investigated the role of MASP-2 in human acute myocardial ischemia in two clinical settings: (1) Acute MI, and (2) Open heart surgery.

Methods: A total of 187 human subjects were enrolled in this study, including 50 healthy individuals, 27 patients who were diagnosed of coronary artery disease (CAD) but without acute MI, 29 patients with acute MI referred for coronary angiography, and 81 cardiac surgery patients with surgically-induced global heart ischemia. Circulating MASP-2 levels were measured by ELISA.

Results: MASP-2 levels in the peripheral circulation were significantly reduced in MI patients compared with those of healthy individuals or of CAD patients without acute MI. The hypothesis that MASP-2 was activated during acute myocardial ischemia was evaluated in cardiac patients undergoing surgically-induced global heart ischemia. MASP-2 was found to be significantly reduced in the coronary circulation of such patients, and the reduction of MASP-2 levels correlated independently with the increase of the myocardial necrosis marker, cardiac troponin I.

Conclusions: These results indicate an involvement of MASP-2 in ischemia-related necrotic myocardial injury in humans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2011.11.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310957PMC
June 2013

Effect of proton pump inhibitors on platelet inhibition activity of clopidogrel in Chinese patients with percutaneous coronary intervention.

Vasc Health Risk Manag 2011 24;7:399-404. Epub 2011 Jun 24.

Boston University, Boston, MA, USA.

Background: The purpose of this study was to examine the effect of proton pump inhibitors (PPI) on the antiplatelet activity of clopidogrel in a consecutive series of Chinese patients after they had received coronary stents.

Methods: A sample of 51 consecutive Chinese patients treated with coronary stents and taking PPI and clopidogrel for more than 30 days were enrolled in this study. Mean values for platelet residual units and percentage inhibition before PPI (+PPI) and 14 days after discontinuation of PPI (-PPI) were compared using the paired t-test.

Results: There was no effect of concomitant use of esomeprazole and clopidogrel or omeprazole and clopidogrel on the inhibition assay, but platelet residual units and percentage inhibition showed statistically significant improvement after stopping lansoprazole in Chinese patients who were on chronic clopidogrel therapy. Clopidogrel resistance existed more frequently in the Chinese-American population examined, and was as high as 68% (+PPI) to 73% (-PPI).

Conclusion: The clopidogrel resistance found is cause for concern, although its relationship with clinical events is currently unknown in this population. Further study with other thienopyridines or genetic variant analysis is suggested.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/VHRM.S22273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141912PMC
November 2011

Perioperative mannan-binding lectin (MBL) patterns in cardiac surgery may correlate with the clinical outcomes in MBL deficient patients.

Ann Thorac Surg 2010 Oct;90(4):1357-8

Department of Anesthesiology, Division of Cardiothoracic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.

Previously we reported a case of abrupt change of postoperative mannan-binding-lectin (MBL) in a patient with preexisting MBL deficiency who expired shortly after cardiac surgery. Herein we report additional cases of 3 more patients with preexisting MBL deficiency who underwent cardiac surgery. Analysis of their blood samples from the perioperative period showed their MBL levels were abruptly increased at 24 hours after surgery. However, 2 patients had a subsequent drop of MBL at 48 hours, and both expired. These data indicated that the postoperative decrease of MBL may have been related with an unfavorable outcome after cardiac surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2010.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039286PMC
October 2010

The viscoelastic properties of microvilli are dependent upon the cell-surface molecule.

Biochem Biophys Res Commun 2010 Jul 4;397(3):621-5. Epub 2010 Jun 4.

Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908, USA.

We studied at nanometer resolution the viscoelastic properties of microvilli and tethers pulled from myelogenous cells via P-selectin glycoprotein ligand 1 (PSGL-1) and found that in contrast to pure membrane tethers, the viscoelastic properties of microvillus deformations are dependent upon the cell-surface molecule through which load is applied. A laser trap and polymer bead coated with anti-PSGL-1 (KPL-1) were used to apply step loads to microvilli. The lengthening of the microvillus in response to the induced step loads was fitted with a viscoelastic model. The quasi-steady state force on the microvillus at any given length was approximately fourfold lower in cells treated with cytochalasin D or when pulled with concanavalin A-coated rather than KPL-1-coated beads. These data suggest that associations between PSGL-1 and the underlying actin cytoskeleton significantly affect the early stages of leukocyte deformation under flow.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bbrc.2010.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907673PMC
July 2010

Compartment syndrome after endoscopic harvest of the great saphenous vein during coronary artery bypass grafting.

Ann Thorac Surg 2010 Jan;89(1):271-3

State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.

Compartment syndrome is a limb-threatening condition often associated with traumatic, crush, burn, and reperfusion injuries. It is characterized by the development of disproportionately severe pain, paresthesias, decreased range of motion, loss of pulse, and a tense, edematous limb. In addition, measured compartment pressures and creatine phosphokinase values are often elevated. The definitive treatment is a decompressive fasciotomy. Compartment syndrome after coronary artery bypass grafting, however, is rare. The few reported cases all occurred in the vein donor leg after open harvest. We present a patient with compartment syndrome after endoscopic harvest of the saphenous vein for coronary artery bypass grafting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2009.06.083DOI Listing
January 2010

Carcinosarcoma of the oesophagus - a rare mixed type of tumor.

J Surg Case Rep 2010 Sep 1;2010(7). Epub 2010 Sep 1.

SUNY Downstate Medical Center, New York, USA.

Oesophageal carcinosarcoma is a rare type of oesophageal cancer composed of both squamous cells and sarcomatous cells. We report a case of a 71 year old man presenting with dysphagia and weight loss. Oesophagogastroduodenoscopy revealed a bulky mass with a preliminary diagnosis of only oesophageal carcinoma, and the oesophageal mass was resected with a transhiatal oesophagectomy. On surgical pathology, it was discovered that the tumor had both squamous cell and sarcomatous cell components, and the final diagnosis was changed to oesophageal carcinosarcoma. We discuss the presentation, differential diagnosis, treatment, and prognosis of this unique entity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jscr/2010.7.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649142PMC
September 2010

Low-dose spironolactone: effects on artery-to-artery vein grafts and percutaneous coronary intervention sites.

Am J Ther 2009 May-Jun;16(3):204-14

Department of Cardiothoracic Surgery, Weill Cornell Medical College, Cornell University, New York, NY 10021, USA.

The efficacy of vein grafts used in coronary and peripheral artery bypass is limited by excessive hyperplasia and fibrosis that occur early after engraftment. In the present study, we sought to determine whether low-dose spironolactone alleviates maladaptive vein graft arterialization and alters intimal reaction to coronary artery stenting. Yorkshire pigs were randomized to treatment with oral spironolactone 25 mg daily or placebo. All animals underwent right carotid artery interposition grafting using a segment of external jugular vein and, 5 days later, underwent angiography of carotid and coronary arteries. At that time, a bare metal stent was placed in the left anterior descending artery and balloon angioplasty was performed on the circumflex coronary artery. Repeat carotid and coronary angiograms were performed before euthanasia and graft excision at 30 days. Angiography revealed that venous grafts of spironolactone-treated animals had lumen diameters twice the size of controls at 5 days, a finding that persisted at 30 days. However, neointima and total vessel wall areas also were 2- to 3-fold greater in spironolactone-treated animals, and there were no differences in vessel wall layer thicknesses or collagen and elastin densities. In the coronary circulation, there were no differences between treatment groups in any vessel wall parameters in either stented or unstented vessels. Taken together, these observations suggest that low-dose spironolactone may exert a novel protective effect on remodeling in venous arterial grafts that does not depend on the reduction of hyperplastic changes but may involve dilatation of the vessel wall.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MJT.0b013e31818bec62DOI Listing
July 2009

Deficiency of complement factor MBL in a patient required cardiac surgery after an acute myocardial infarction with underlining chronic lymphocytic leukemia.

Int J Cardiol 2010 Mar 26;139(2):e24-6. Epub 2008 Nov 26.

Increasing evidence suggests that Mannan-binding lectin (MBL), the initial factor of the lectin pathway of complement, plays a role in cardiovascular diseases, i.e. inversely associated with risk of myocardial infarction (MI). In the present case, a patient with MBL deficiency underwent coronary artery bypass grafting (CABG) after an acute MI with underlining chronic lymphocytic leukemia (CLL). Post-operatively, the patient had a cerebral vascular accident and eventually expired. Analysis of his blood samples from pre-, intra-, and post-operative periods showed that MBL levels abruptly increased post-operatively. We hypothesize that the post-operative increase of MBL in the patient with pre-existing MBL deficiency may contribute to systemic inflammation, causing a detrimental effect after cardiac surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2008.10.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279176PMC
March 2010

Cardiac surgery in select nonagenarians: should we or shouldn't we?

Ann Thorac Surg 2008 Mar;85(3):854-60

Department of Cardiothoracic Surgery, Center for Complementary and Integrative Medicine, Weill Cornell Medical College, New York, New York 10021, USA.

Background: Patients aged 90 years and older represent a rapidly growing subset of the population, many of whom are functionally limited by cardiovascular disease. Clinical decision making about cardiac surgical intervention in nonagenarians is hindered by a paucity of data examining survival outcomes in this population.

Methods: A consecutive series of nonagenarians who underwent cardiac operations between 1995 and 2004 were retrospectively reviewed. Data collection included baseline preoperative clinical status, intraoperative characteristics, and perioperative course. Area under the Kaplan-Meier survival estimate method was used to calculate mean survival.

Results: Cardiac surgical procedures were done in 49 patients (51% male); their mean age was 91.9 years (range, 90 to 97 years). Operative mortality was 8% (n = 4). Multivariate Cox proportional hazards models found preoperative chronic renal insufficiency (hazard ratio [HR], 4.88; 95% confidence interval [CI], 1.53 to 15.55; p = 0.007) and ejection fraction (HR, 0.96; 95% CI, 0.93 to 1.00; p = 0.033) were independently associated with death. Overall mean survival was 5.1 +/- 0.5 years (median, 5.2 years). Quality of life outcomes were similar to that of two related norm-based populations based on age and disease process.

Conclusions: Cardiac surgical procedures can be performed safely and with therapeutic benefit in carefully selected nonagenarians. We consider physiologic indicators, social factors, and patient preferences to be the main determinants in the patient selection process. Our results support the need for more proactive intervention in symptomatic nonagenarian patients as it relates to earlier consideration of elective, rather than emergency cardiac operations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2007.10.074DOI Listing
March 2008

Trends of antiretroviral drug resistance in treatment-naive patients with human immunodeficiency virus type 1 infection in Taiwan.

J Antimicrob Chemother 2008 Mar 28;61(3):689-93. Epub 2008 Jan 28.

Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan.

Objectives: To determine the prevalence and trends of antiretroviral drug resistance among HIV-1-infected Taiwanese patients who have been provided with free-of-charge antiretroviral therapy (ART) since 1990.

Methods: Blood samples collected from 786 HIV-1-infected patients from 1999 to 2006 were subjected to genotypic resistance assay. Antiretroviral resistance mutations were identified in accordance with the antiretroviral resistance mutation list of the International AIDS Society-USA Consensus Guidelines. Trends of resistance were studied in patients enrolled in two periods: before (period 1, January 1999 to December 2003) and after (period 2, January 2004 to December 2006) the CRF07_BC outbreak among injection drug users (IDUs).

Results: The frequency of HIV-1 isolates harbouring one or more primary mutations associated with antiretroviral resistance to reverse transcriptase inhibitors or protease inhibitors increased significantly from 6.6% in period 1 to 12.7% in period 2 (P = 0.003). A significant increase in prevalence of antiretroviral drug resistance was observed among men who have sex with men and patients infected with HIV subtype B. In multivariate analysis, hepatitis C virus (HCV) exposure, which exhibited collinearity with injection drug use and infection with CRF07_BC, represented a lower risk for infection with resistant viruses.

Conclusions: Our findings suggest that the prevalence of antiretroviral resistance has increased in Taiwan over the past 8 years after the introduction of combination ART. IDUs who were HCV-seropositive and infected with CRF07_BC were at lower risk for infection with antiretroviral-resistant viruses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jac/dkn002DOI Listing
March 2008

A community-derived outbreak of adenovirus type 3 in children in Taiwan between 2004 and 2005.

J Med Virol 2008 Jan;80(1):102-12

Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan.

An outbreak of respiratory adenovirus infection in children was observed in northern Taiwan between November 2004 and February 2005. Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to determine the serotype(s) of 172 adenovirus isolates in the outbreak period, we found that adenovirus type 3 (Ad3) was the predominant type (87.2%), followed by Ad2 (6.4%), Ad1 (4.1%), Ad7 (1.2%), Ad4 (0.6%), and Ad5 (0.6%). The genotype of Ad3 was analyzed for 15 isolates from the outbreak period by RFLP of the full-length genome. All these isolates belonged to genotype Ad3a2. Compared with the Ad3-infected patients in the baseline period, a significantly higher proportion of Ad3-infected patients in the outbreak period had severe infections (58.0% vs. 40.2%, P = 0.01), which included bronchopneumonia (28.7%), exudative tonsillitis (24.1%), and tonsillitis (16.1%). Moreover, patients with severe infections were significantly younger than those without (4.10 vs. 8.15 years, P < 0.001). In summary, our study demonstrated that Ad3 was the predominant serotype responsible for the respiratory adenovirus outbreak in northern Taiwan during 2004-2005 and was associated with severe infections in the outbreak period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jmv.21045DOI Listing
January 2008

Effects of ischemic preconditioning and adenosine pretreatment on myocardial function and energetics in a clinically relevant model.

Life Sci 2007 Oct 16;81(17-18):1355-61. Epub 2007 Sep 16.

Department of Cardiothoracic Surgery, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.

Preconditioning (PC) is a potential approach to myocardial protection. We hypothesize that brief ischemia or adenosine given prior to an extended period of warm ischemia may prevent myocardial stunning by altering myocardial metabolism. Using a global ischemia model, 19 dogs were subjected to no PC(control), two episodes of ischemia (2 min of global ischemia followed by 3 min of reperfusion) (IPC), or 30 min of pulmonary artery adenosine infusion (AP), to a maximum of 350 microg/kg/min, followed by 20 min of global warm ischemia on cardiopulmonary bypass. Left ventricular pressure-volume loops and myocardial oxygen consumption (MVO(2)) were measured at baseline and after 60 min of reperfusion, on right heart bypass. All data were compared between baseline and reperfusion. Load independent left ventricular function, defined as preload recruitable stroke work (PRSW), decreased in control and IPC groups (72+/-7%, 71+/-12%, respectively). AP blunted the decrease in PRSW (45+/-9%, p<.05 compared to control). Myocardial energetic conversion efficiency, defined as the slope of the MVO(2)-Stroke work relationship was not significantly changed for controls (2.17+/-0.47 to 1.84+/-0.68) and IPC (2.99+/-0.45 to 2.16+/-0.65), but was for AP (1.16+/-0.88 to 5.71+/-1.66, p<0.04). IPC did not prevent ventricular stunning or alter myocardial energetics. AP reduced ventricular stunning but resulted in worsened myocardial energy efficiency. The benefits to ventricular function of the adenosine pretreatment protocol used in this study were only possible at a cost of higher metabolic requirements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lfs.2007.08.037DOI Listing
October 2007

Integration of genomics, proteomics, and imaging for cardiac stem cell therapy.

Eur J Nucl Med Mol Imaging 2007 Jun;34 Suppl 1:S20-6

Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA.

Cardiac stem cell therapy is beginning to mature as a valid treatment for heart disease. As more clinical trials utilizing stem cells emerge, it is imperative to establish the mechanisms by which stem cells confer benefit in cardiac diseases. In this paper, we review three methods - molecular cellular imaging, gene expression profiling, and proteomic analysis - that can be integrated to provide further insights into the role of this emerging therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-007-0437-yDOI Listing
June 2007

Current technique for resection of mediastinal goiter.

Ear Nose Throat J 2006 Sep;85(9):609-11

Division of Head and Neck Surgery, New York Hospital Medical Center of Queens, New York City, USA.

We have developed a combined surgical technique involving traction sutures, the harmonic scalpel, and laryngeal nerve monitoring for the removal of mediastinal goiters. This technique is safe, expeditious, and effective; it minimizes the risk of blood loss or nerve injury; and it obviates the need for sternotomy. During a 4-year period, we performed this operation on 21 patients. We observed only two complications: one patient developed postoperative seroma 1 week after surgery and another experienced vocal fold paralysis after intentional sacrifice of the recurrent laryngeal nerve, which was encompassed by cancer. No other recurrent laryngeal nerve was injured. Operative blood loss was negligible, no systemic infection or permanent hypoparathyroidism was observed, and no patient required a chest tube or chest incision. Almost all patients were discharged home on postoperative day 1.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2006

Intraocular lens power calculation after laser in situ keratomileusis: Aphakic refraction technique.

J Cataract Refract Surg 2006 Mar;32(3):435-7

Mackool Eye Institute, Astoria, New York, USA.

Purpose: To evaluate the accuracy of a new method of intraocular lens (IOL) power calculation for eyes having cataract extraction after previous laser in situ keratomileusis (LASIK).

Setting: Clinical private practice and ambulatory surgical center, Astoria, New York, USA.

Methods: This retrospective study was of 12 eyes of 9 patients who presented for cataract extraction after previous LASIK. Cataract removal was performed under topical anesthesia without IOL implantation. Approximately 30 minutes later, a manifest aphakic refraction was performed. The calculation of the IOL power was obtained by using an algorithm derived from previous experience with secondary IOL implantation (Mackool algorithm). The patient then returned to the operating room for lens implantation (aphakic refraction technique).

Results: The refractive error 2 weeks postoperatively, defined as the difference between the intended and actual refractive outcome, ranged from 0.50 diopter (D) of unintended hyperopia to 0.75 (D) of unintended myopia.

Conclusions: The aphakic refraction technique provided an extremely accurate postoperative refraction in eyes having cataract with IOL implantation surgery after previous LASIK. Although the pool sample was small (12 eyes) and the range of the aphakic refraction was limited (+8.50 to 12.375 D), the technique was found to be remarkably accurate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcrs.2005.11.045DOI Listing
March 2006

Epicardial beating heart cryoablation using a novel argon-based cryoclamp and linear probe.

J Thorac Cardiovasc Surg 2006 Feb 18;131(2):403-11. Epub 2006 Jan 18.

New York Presbyterian Hospital-Weill Cornell Medical Center, Department of Cardiothoracic Surgery, New York, NY, USA.

Objective: Epicardial, beating heart cryoablation for the treatment of atrial fibrillation may be limited by heat from intracardiac blood flow. We therefore evaluated the ability to create cryolesions using an argon-based cryoclamp device, which temporarily occludes blood flow and facilitates transmurality.

Methods: Six mongrel dogs underwent sternotomy. A clamp employing a 10-cm argon-based linear cryoablation device was used epicardially to isolate the pulmonary veins and left atrial appendage. After clamping of lesions, the probe was removed from the cryoclamp device, and the remaining linear lesions, analogous to the Cox maze III, were performed. Pulmonary vein stenosis was evaluated with the use of magnetic resonance imaging. Left atrial function and pulmonary venous flow velocities were assessed with transesophageal echocardiography. Transmurality was confirmed both electrically and histologically. Animals were then put to death at 30 days.

Results: All acute and chronic cryoclamp lesions produced conduction block. There was no change in right (RPV) or left pulmonary vein (LPV) diameter on the basis of magnetic resonance imaging at baseline and at planned death (RPV-1, 19.6 +/- 2.9 mm vs 16.9 +/- 2.8 mm, P = .22; RPV-2, 13.2 +/- 2.0 mm vs 11.8 +/- 1.6 mm, P = .22; and LPV, 12.2 +/- 2.4 mm vs 11.2 +/- 1.9 mm, P = .30). Left atrial function and pulmonary venous flow velocities were unchanged. Tissue sections determined transmurality in 93% of cryoclamp lesions and 84% of linear ablations performed with the 10-cm malleable probe.

Conclusions: Epicardial application of this cryoclamp device on the beating heart produced transmural lesions, which persisted 30 days. Linear epicardial cryoablation was not as effective as the cryoclamp device at producing consistent transmural lesions. This novel, versatile device may be useful in treating patients with atrial fibrillation on the beating heart without cardiopulmonary bypass.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtcvs.2005.10.048DOI Listing
February 2006

Surgical treatment of atrial fibrillation using argon-based cryoablation during concomitant cardiac procedures.

Circulation 2005 Aug;112(9 Suppl):I1-6

Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY 10021, USA.

Background: The development of ablative energy sources has simplified the surgical treatment of atrial fibrillation (AF) during concomitant cardiac procedures. We report our results using argon-based endocardial cryoablation for the treatment of AF in patients undergoing concomitant cardiac procedures.

Methods And Results: Sixty-three patients with AF who were undergoing concomitant cardiac procedures had the same left atrial endocardial lesion set using a flexible argon-based cryoablative device. Mean age was 65.1+/-1.3 years. Sixty-two percent had permanent AF, whereas 38% had paroxysmal AF. Mean duration of AF was 30.5+/-4.8 months. Mean left atrial diameter was 5.5+/-0.1 cm. Mean ejection fraction was 45+/-1.4%. All endocardial lesions were performed for 1 minute once tissue temperature reached -40 degrees C. Follow-up echocardiograms were obtained to determine freedom from AF. Kaplan-Meier analysis demonstrated an 88.5% freedom from AF rate at 12 months. Ablation time was 16.8+/-0.6 minutes. There were no in-hospital deaths and no strokes. Twelve patients (19%) required postoperative permanent pacemaker placement.

Conclusions: Cryoablation using this flexible argon-based device for the treatment of AF during concomitant cardiac procedures was safe and effective, with 88.5% of patients free from AF at 12 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.104.524363DOI Listing
August 2005

Comparison of open versus bedside percutaneous dilatational tracheostomy in the cardiothoracic surgical patient: outcomes and financial analysis.

Ann Thorac Surg 2005 Jun;79(6):1879-85

Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Cornell University, New York, New York 10021, USA.

Background: The clinical and financial outcomes of a change in practice from traditional tracheostomy (open) to bedside percutaneous dilatational tracheostomies (PDT) was evaluated in patients who underwent cardiothoracic surgery.

Methods: During 3 years, 86 tracheostomies were performed in more than 4,000 patients who underwent cardiac surgery, 59 open and 27 PDT. A retrospective analysis was performed comparing clinical and financial outcomes of the two groups.

Results: There were no significant differences in demographics, medical histories, operations, or complications between open and PDT except the open group experienced more postoperative arrhythmias (70% [41 of 59] versus 44% [12 of 27], p < 0.05). Total savings associated with 1 year of PDT was $84,000, for a projected discounted savings of $283,000 during the study period. A sensitivity analysis of critical economic variables (number of tracheostomies per year, cost of operating room per minute, cost of intensive care unit bed per day) was included to evaluate the impact on cost savings. The net present value analysis, which discounts future savings by an appropriate interest rate, yielded a range of projected savings of PDT more than 5 years of $73,000 to $541,000 with a best estimate of $304,000 using figures established from our 3-year experience with PDT. Sensitivity analysis of the net present value for each critical variable was $227,000 per day of reduced intensive care unit length of stay, $180,000 per cost of operating room avoidance, $100,000 per intensive care unit bed cost per day, and $11,000 per additional tracheostomy per year.

Conclusions: There were no significant clinical differences between open and PDT in cardiac surgery patients during the 3-year study period; however, PDT offered significant cost savings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2004.10.042DOI Listing
June 2005
-->