Scholars@Duke
Brittany Anne Zwischenberger

Brittany Anne Zwischenberger

Associate Professor of Surgery
Surgery, Cardiovascular and Thoracic Surgery

Selected Publications

Outcomes of Leaflet Resection vs Chordal Replacement for Degenerative Mitral Regurgitation.

Journal Article Ann Thorac Surg · November 2024 BACKGROUND: Debate persists regarding the outcomes of leaflet resection (RESECT) vs chordal replacement (CHORD) for degenerative mitral regurgitation. Our aim was to compare early and late outcomes of the RESECT vs CHORD techniques for degenerative mitral ... Full text Link to item Cite

Late Outcomes of Porcine and Pericardial Bioprostheses After Mitral Valve Replacement in 1162 Patients.

Journal Article Ann Thorac Surg · October 2024 BACKGROUND: Debate continues regarding the superiority of porcine vs pericardial bioprostheses, and data relevant to this comparison are scant. This study compared late survival and structural valve deterioration of porcine and pericardial mitral valve pro ... Full text Link to item Cite

Durability of porcine and pericardial prostheses in tricuspid valve replacement

Conference JTCVS Open · October 1, 2024 Objective: Biologic valves dominate tricuspid valve replacement, yet data on different valve types are lacking. We compare the survival and durability of porcine and pericardial tricuspid prostheses. Methods: A retrospective review of consecutive patients ... Full text Cite

18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations From ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS.

Journal Article JACC Cardiovasc Imaging · June 2024 This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the eva ... Full text Link to item Cite

18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS.

Journal Article Heart Rhythm · May 2024 This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the eva ... Full text Link to item Cite

Quality improvement initiative to increase radial artery usage as a second arterial conduit in coronary artery bypass grafting

Journal Article Interdisciplinary Cardiovascular and Thoracic Surgery · May 1, 2024 OBJECTIVES: Use of radial artery as a second arterial graft, compared to a saphenous vein, in coronary artery bypass grafting (CABG) can improve late outcomes. However, the radial artery remains underutilized. We initiated a quality improvement (QI) initia ... Full text Cite

18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS.

Journal Article J Nucl Cardiol · April 2024 This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the eva ... Full text Link to item Cite

Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.

Journal Article J Am Heart Assoc · March 19, 2024 BACKGROUND: Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quan ... Full text Link to item Cite

Late Survival After Redo Mitral Operation With Minithoracotomy Compared With Sternotomy.

Journal Article Ann Thorac Surg · February 2024 BACKGROUND: The long-term effectiveness of minithoracotomy over redo median sternotomy for reoperative mitral operation is not well described. Here we present long-term survival after reoperative mitral operation based on operative approach. METHODS: Adult ... Full text Link to item Cite

Infarct exclusion repair of postmyocardial infarction ventricular septal rupture with a hybrid patch and septal occluder device compared with patch only.

Conference JTCVS Tech · December 2023 OBJECTIVE: We developed a hybrid technique for repairing post-myocardial infarction (MI) ventricular septal defect (VSD) that combines infarct exclusion with patch and a nitinol-mesh septal occluder device (SOD) to provide a scaffold to support the damaged ... Full text Link to item Cite

Scoping review of percutaneous mechanical aspiration for valvular and cardiac implantable electronic device infective endocarditis.

Journal Article Clin Microbiol Infect · December 2023 BACKGROUND: Percutaneous mechanical aspiration (PMA) of intravascular vegetations is a novel strategy for management of patients with infective endocarditis (IE) who are at high risk of poor outcomes with conventional cardiac surgery. However, clear indica ... Full text Link to item Cite

Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection.

Journal Article Semin Thorac Cardiovasc Surg · August 25, 2023 Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with ... Full text Link to item Cite

Optimal circulatory arrest temperature for aortic hemiarch replacement with antegrade brain perfusion.

Conference J Thorac Cardiovasc Surg · May 2023 OBJECTIVE: This study sought to identify the optimal temperature for moderate hypothermic circulatory arrest in patients undergoing elective hemiarch replacement with antegrade brain perfusion. METHODS: The Society of Thoracic Surgeons adult cardiac surger ... Full text Link to item Cite

Comparing Consumer-Directed Hospital Rankings With STS Adult Cardiac Surgery Database Outcomes.

Journal Article Ann Thorac Surg · February 2023 BACKGROUND: Public interest in stratifying hospital performance has led to the proliferation of commercial, consumer-oriented hospital rankings. In cardiac surgery, little is known about how these rankings correlate with clinical registry quality ratings. ... Full text Link to item Cite

Minimally invasive surgical coronary artery bypass in women

Journal Article Annals of Cardiothoracic Surgery · January 1, 2023 Minimally invasive coronary artery bypass grafting (CABG) has emerged as a viable alternative to conventional sternotomy CABG in select patients requiring coronary revascularization. Specific techniques vary, but minimally invasive CABG (i.e., MIDCAB) usua ... Full text Cite

Aortic Prosthetic Valve Endocarditis: Analysis of The Society of Thoracic Surgeons Database.

Journal Article Ann Thorac Surg · December 2022 BACKGROUND: This study sought to characterize the current US experience of aortic prosthetic valve endocarditis (PVE) compared with native valve endocarditis (NVE). METHODS: The Society of Thoracic Surgeons Database was queried for entries of active aortic ... Full text Link to item Cite

Use of computed tomography (CT) for preoperative planning in patients undergoing coronary artery bypass grafting (CABG).

Journal Article J Card Surg · December 2022 Surgical planning for coronary artery bypass grafting (CABG) can be enhanced with the use of computed tomographic (CT) imaging to better understand the surgical field for optimal conduct of the case as well as risk assessment for outcomes. CABG via primary ... Full text Link to item Cite

Outcomes of acute type A aortic dissection during the COVID-19 pandemic: An analysis of the Society of Thoracic Surgeons Database.

Journal Article J Card Surg · December 2022 PURPOSE: There have been reported reductions of hospital presentation for acute cardiovascular conditions such as myocardial infarction and acute type A aortic dissection (ATAAD) in the United States during the COVID-19 pandemic. This study examined presen ... Full text Link to item Cite

Role of cardiac magnetic resonance (CMR) in planning ventricular septal myomectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).

Journal Article J Card Surg · December 2022 Septal myectomy is currently the gold standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure needs to be tailored and performed in a personalized fashion, taking into consideration the anatomic and ph ... Full text Link to item Cite

Coronary Endarterectomy: Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database.

Conference Ann Thorac Surg · September 2022 BACKGROUND: Coronary endarterectomy (CE) is an uncommon and often unplanned technique used to approach difficult targets during coronary artery bypass grafting (CABG). We evaluated the outcomes of CABG with CE (CE-CABG) using The Society of Thoracic Surgeo ... Full text Link to item Cite

Sex Differences in Coronary Artery Bypass Grafting Techniques: A Society of Thoracic Surgeons Database Analysis.

Journal Article Ann Thorac Surg · June 2022 BACKGROUND: Female patients with coronary artery disease have inferior outcomes compared with male patients, including higher mortality after coronary artery bypass graft surgery (CABG). We aimed to evaluate the association of female sex with the use of gu ... Full text Link to item Cite

Sex-Related Outcomes of Medical, Percutaneous, and Surgical Interventions for Coronary Artery Disease: JACC Focus Seminar 3/7.

Journal Article J Am Coll Cardiol · April 12, 2022 Biological and sociocultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the 2 sexes. Worse outcomes in women have been desc ... Full text Link to item Cite

2021 ACC/AHA/SCAI Coronary Artery Revascularization Guidelines for Managing the Nonculprit Artery in STEMI.

Journal Article JACC Case Rep · April 6, 2022 The 2021 Coronary Artery Disease revascularization guidelines of the American College of Cardiology (ACC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI) provide recommendations for managing no ... Full text Link to item Cite

Heated Humidified Breathing Circuit Rewarming in Hypothermic Patients Post-Cardiopulmonary Bypass-Pilot Study.

Journal Article J Cardiothorac Vasc Anesth · April 2022 OBJECTIVES: Hypothermia on intensive care unit (ICU) admission after cardiac surgery and cardiopulmonary bypass is common. It contributes to postoperative complications including shivering, coagulopathy, increased blood loss and transfusion requirements, m ... Full text Link to item Cite

Sustained results of robotic mitral repair in a lower volume center with extensive minimally invasive mitral repair experience.

Journal Article J Robot Surg · February 2022 The literature for robotic mitral repair is dominated by a small number of large volume institutions, and intermediate-term outcomes out to 5 years are rare. Whether and under what circumstances a lower volume institution could obtain durable outcomes is n ... Full text Link to item Cite

Methodological Standards for the Design, Implementation, and Analysis of Randomized Trials in Cardiac Surgery: A Scientific Statement From the American Heart Association.

Journal Article Circulation · January 25, 2022 Cardiac surgery presents specific methodological challenges in the design, implementation, and analysis of randomized controlled trials. The purposes of this scientific statement are to review key standards in cardiac surgery randomized trial design and im ... Full text Link to item Cite

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Journal Article Journal of the American College of Cardiology · January 18, 2022 Aim: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideli ... Full text Cite

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Journal Article Circulation · January 18, 2022 AIM: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideli ... Full text Link to item Cite

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Journal Article Journal of the American College of Cardiology · January 18, 2022 Aim: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment o ... Full text Cite

Coronary surgery in women: How can we improve outcomes

Journal Article JTCVS Techniques · December 1, 2021 Full text Cite

Cardiac Surgery in Women in the Current Era: What Are the Gaps in Care?

Journal Article Circulation · October 5, 2021 Cardiovascular disease remains the leading cause of morbidity and mortality for women in United States and worldwide. One in 3 women dies from cardiovascular disease, and 45% of women >20 years old have some form of CVD. Historically, women have had higher ... Full text Link to item Cite

Reply: When Will We Stop Debating on the Value of TEE in CABG?

Journal Article Journal of the American College of Cardiology · October 2021 Full text Cite

Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Journal Article J Am Coll Cardiol · July 13, 2021 BACKGROUND: The impact of utilization of intraoperative transesophageal echocardiography (TEE) at the time of isolated coronary artery bypass grafting (CABG) on clinical decision making and associated outcomes is not well understood. OBJECTIVES: The purpos ... Full text Link to item Cite

Coronary Anastomosis Simulation: Directed Interventions to Optimize Success.

Journal Article Ann Thorac Surg · June 2021 BACKGROUND: The role of simulation-based training in coronary artery bypass grafting remains undefined. Barriers to simulator use include clinical and personal obligations, insufficient materials, and lack of mentorship. The purpose of this study was to im ... Full text Link to item Cite

Complications after Ravitch versus Nuss repair of pectus excavatum: A Society of Thoracic Surgeons (STS) General Thoracic Surgery Database analysis.

Journal Article Surgery · June 2021 BACKGROUND: There are conflicting reports in the literature comparing outcomes after open Ravitch and minimally invasive Nuss procedures for pectus excavatum repair, and there is relatively little data available comparing the outcomes of these procedures p ... Full text Link to item Cite

Adipose-Derived Inflammatory and Coagulant Mediators in Patients With Sepsis.

Journal Article Shock · May 1, 2021 Results from preclinical sepsis studies using rodents are often criticized as not being reproducible in humans. Using a murine model, we previously reported that visceral adipose tissues (VAT) are highly active during the acute inflammatory response, servi ... Full text Link to item Cite

Robotic versus port-access mitral repair: A propensity score analysis.

Journal Article J Card Surg · April 2021 BACKGROUND: Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented. METHODS: A retrospective analysis was performed on 129 ROBO and 628 PORT mitral repairs at one ... Full text Open Access Link to item Cite

It's not you, It's me: The influence of patient and surgeon gender on patient satisfaction scores.

Journal Article Am J Surg · November 2020 BACKGROUND: Surgeons face the unique challenge of being responsible for both clinical encounters and surgical outcomes. We aim to explore how patient evaluations of surgeons may be influenced by patient and provider factors. METHODS: Patient responses from ... Full text Link to item Cite

The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States.

Journal Article Ann Thorac Surg · October 2020 BACKGROUND: The rise in the number of valve operations performed for infective endocarditis (IE) due to drug use is an important manifestation of the opioid epidemic. This study characterized national trends and outcomes of valve surgery for drug use-assoc ... Full text Link to item Cite

Using a Regent Aortic Valve in a Small Annulus Mitral Position Is a Viable Option.

Journal Article Ann Thorac Surg · April 2018 BACKGROUND: Outcome of mitral valve replacement in extreme scenarios of small mitral annulus with the use of the Regent mechanical aortic valve is not well documented. METHODS: Records were examined in 31 consecutive patients who underwent mitral valve rep ... Full text Open Access Link to item Cite

Outcomes after Ventral Hernia Repair Using the Rives-Stoppa, Endoscopic, and Open Component Separation Techniques.

Journal Article Am Surg · March 1, 2018 Complex ventral hernias remain a challenge for general surgeons despite advances in minimally invasive surgical techniques. This study compares outcomes following Rives-Stoppa (RS) repair, components separation technique with mesh (CST-M) or without mesh ( ... Link to item Cite

Doxycycline alters collagen composition following ventral hernia repair.

Journal Article Surg Endosc · April 2017 BACKGROUND: Doxycycline, a nonspecific metalloproteinase (MMP) inhibitor, has been demonstrated to impact the strength of the polypropylene (PP) mesh-repaired hernia with an increase in the deposition of collagen type 1. The impact of doxycycline with porc ... Full text Link to item Cite

Doxycycline shows dose-dependent changes in hernia repair strength after mesh repair.

Journal Article Surg Endosc · May 2016 BACKGROUND: Ventral hernia is a commonly occurring surgical problem. Our earlier studies have shown that a 30 mg/kg dose of doxycycline can significantly impact the strength of polypropylene (PP) mesh in a rat hernia repair model at 6 and 12 weeks. The obj ... Full text Link to item Cite

Venous Thromboembolism Prophylaxis For Esophagectomy: A Survey of Practice Patterns Among Thoracic Surgeons.

Conference Ann Thorac Surg · February 2016 BACKGROUND: Current guidelines for gastrointestinal cancer surgical intervention in high-risk patients recommend postoperative venous thromboembolism (VTE) chemical prophylaxis for 4 weeks with low-dose unfractionated heparin or low-molecular-weight hepari ... Full text Link to item Cite

Laparoscopic Robot-Assisted Diaphragm Plication.

Journal Article The Annals of thoracic surgery · January 2016 Minimally invasive approaches to diaphragm plication for eventration include thoracoscopic and laparoscopic techniques. The elevated hemidiaphragm and ribs limit thoracoscopic techniques. We report our modification of the laparoscopic approach using roboti ... Full text Cite

Increased coagulation and suppressed generation of activated protein C in aged mice during intra-abdominal sepsis.

Journal Article Am J Physiol Heart Circ Physiol · January 15, 2015 Sepsis is a life-threatening clinical condition that is particularly serious among the elderly who experience considerably higher mortality rates compared with younger patients. Using a sterile endotoxemia model, we previously reported age-dependent mortal ... Full text Link to item Cite

Analysis of 30-day readmission after aortoiliac and infrainguinal revascularization using the American College of Surgeons National Surgical Quality Improvement Program data set.

Journal Article J Vasc Surg · November 2014 OBJECTIVE: This study analyzed 30-day hospital readmissions after aortoiliac (AI) and infrainguinal (II) revascularization to further characterize readmissions and to identify modifiable targets for reducing readmission rates. METHODS: We performed a retro ... Full text Link to item Cite

Late reoperation for retained gallstone after laparoscopic cholecystectomy.

Journal Article Surg Laparosc Endosc Percutan Tech · February 2014 Complications due to retained gallstones after a laparoscopic cholecystectomy occur in 1.7 per 1000 cases. Significant delay to definitive diagnosis and treatment is common due to late presentation and nonspecific symptoms. Despite the low frequency, compl ... Full text Link to item Cite

Meta-analysis of the correlation between chronic cerebrospinal venous insufficiency and multiple sclerosis.

Journal Article Vasc Endovascular Surg · November 2013 PURPOSE: To determine whether a correlation exists between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS). MATERIALS AND METHODS: A meta-analysis of the current literature was performed to evaluate the frequency of CCSVI, di ... Full text Link to item Cite

Drug-eluting stents in critical limb ischemia: A systematic review of long-term outcomes

Journal Article Italian Journal of Vascular and Endovascular Surgery · September 1, 2013 Endovascular options for infrapopliteal arterial disease are growing and drug-eluting stents (DES) are becoming a viable option. Several studies have demonstrated superior patency during one-year follow-up; however, long-term performance of DES in infrapop ... Cite

A systematic review of morphea treatments and therapeutic algorithm.

Journal Article J Am Acad Dermatol · November 2011 BACKGROUND: Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care. OBJECTIVE: We sought to create an evidence-based therapeutic algorithm. METHODS: We reviewed ... Full text Link to item Cite

Etiology of uncompleted exercise stress testing after ED chest pain evaluation.

Journal Article Am J Emerg Med · May 2011 OBJECTIVE: Emergency department (ED) chest pain protocols often include an exercise stress test (EST) in an outpatient setting to further risk stratify patients initially identified as low risk for acute coronary syndrome. Our goal was to characterize the ... Full text Link to item Cite

Placental site trophoblastic tumor presenting as a friable cervical mass.

Journal Article Eur J Gynaecol Oncol · 2010 PURPOSE OF INVESTIGATION: Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic neoplasia (GTN) and primarily composed of intermediate trophoblasts. In contrast to other forms of GTN, PSTT presents with only mildly elevat ... Link to item Cite

Artificial lung: progress and prototypes.

Journal Article Expert Rev Med Devices · July 2006 Lung disease is the fourth leading cause of death (one in seven deaths) in the USA. Acute respiratory distress syndrome (ARDS) affects approximately 150,000 patients a year in the USA, and an estimated 16 million Americans are afflicted with chronic lung d ... Full text Link to item Cite