Scholars@Duke
Jeffrey Giles Gaca

Jeffrey Giles Gaca

Associate Professor of Surgery
Surgery, Cardiovascular and Thoracic Surgery
jeffrey.gaca@duke.edu
Box 31174 Med Ctr, Durham, NC 27710
Dept of Surgery, Durham, NC 27710

Selected Publications

Five-Year Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Women: A Systematic Review and Meta-Analysis.

Journal Article Eur J Cardiothorac Surg · December 1, 2025 OBJECTIVES: Women patients with aortic stenosis (AS) exhibit distinct anatomic and physiologic features that may influence outcomes after valve replacement. While transcatheter aortic valve replacement (TAVR) has shown early advantages over surgical aortic ... Full text Link to item Cite

Relative Importance of Timing vs Size of Preoperative Stroke for Valve Operation in Infective Endocarditis.

Journal Article Ann Thorac Surg · August 27, 2025 BACKGROUND: The optimal timing of operation for infective endocarditis with preoperative stroke remains unclear. METHODS: Adults undergoing an operation for acute aortic or mitral valve infective endocarditis were reviewed from our institutional database f ... Full text Link to item Cite

Imaging findings associated with costoclavicular intervention during lead extraction.

Journal Article Heart Rhythm · July 2025 BACKGROUND: Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. It is not known whether preprocedural ... Full text Link to item Cite

Incidence and Risk Factors for Permanent Pacemaker Implantation After Tricuspid Valve Repair.

Journal Article Ann Thorac Surg Short Rep · March 2025 BACKGROUND: Although the likelihood of needing a permanent pacemaker (PPM) after tricuspid valve (TV) repair has been thought to be low compared with TV replacement, the incidence and determinants are controversial. This study aimed to evaluate the inciden ... Full text Link to item Cite

SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement.

Journal Article J Soc Cardiovasc Angiogr Interv · March 2025 Transcatheter aortic valve replacement (TAVR) has become a widely accepted procedure for treating patients with symptomatic aortic stenosis. While transfemoral access remains the primary route due to its lower complication rates and favorable outcomes, a s ... Full text Link to item Cite

Neurocognitive Dysfunction After Short (<20 Minutes) Duration Hypothermic Circulatory Arrest.

Journal Article Ann Thorac Surg · February 2025 BACKGROUND: It has long been held that the safe duration of hypothermic circulatory arrest (HCA) is at least 25 to 30 minutes. However, this belief is based primarily on clinical outcomes research and has not been systematically investigated using more sen ... Full text Link to item Cite

Clamshell thoracosternotomy for single-stage repair of select aortic arch pathologies.

Journal Article JTCVS Open · February 2025 OBJECTIVE: Although median sternotomy is widely used for aortic arch repair, the distal extent of arch replacement is limited with this approach. Bilateral thoracosternotomy (clamshell) represents an alternate and underappreciated strategy that allows for ... Full text Link to item Cite

Alfieri Stitch (Edge To Edge) in Degenerative Mitral Valve Repair: Characteristics and Late Durability in 648 Patients

Journal Article Journal of Cardiac Surgery · January 1, 2025 Background: Mitral valve repair with the edge-to-edge technique (Alfieri stitch) has been described for over 20 years, yet little is published on late durability and potential risk of mitral stenosis remains controversial. The primary objective of this stu ... Full text Cite

Axillary Artery Versus Femoral or Central Arterial Cannulation in Minithoracotomy Mitral Surgery: Is There a Difference in Early Outcomes?

Journal Article Innovations (Phila) · 2025 OBJECTIVE: Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery. METHODS ... Full text Link to item Cite

Alfieri Stitch in Minithoracotomy Repair of Degenerative Mitral Regurgitation: Potential Role and Outcomes.

Journal Article Innovations (Phila) · 2025 OBJECTIVE: The Alfieri stitch is a mitral repair technique that can easily be applied in less invasive approaches to the mitral valve. However, the Alfieri stitch is seldom used and has raised concerns about producing mitral stenosis or recurrent regurgita ... Full text Link to item Cite

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 2024 ObjectiveBiologic 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.MethodsA retrospective review of consecut ... Full text Cite

Long-term outcomes for hybrid aortic arch repair.

Journal Article J Vasc Surg · April 2024 OBJECTIVE: Since its inception in the early 2000s, hybrid arch repair (HAR) has evolved from novel approach to well-established treatment modality for aortic arch pathology in appropriately selected patients. Despite this nearly 20-year history of use, lon ... Full text Link to item Cite

Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest Trial (GOT ICE): A Randomized Clinical Trial Comparing Outcomes After Aortic Arch Surgery.

Journal Article Circulation · February 27, 2024 BACKGROUND: Deep hypothermia has been the standard for hypothermic circulatory arrest (HCA) during aortic arch surgery. However, centers worldwide have shifted toward lesser hypothermia with antegrade cerebral perfusion. This has been supported by retrospe ... 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

Tailored approach and outcomes of aortic arch reconstruction after acute type A dissection repair.

Journal Article J Thorac Cardiovasc Surg · October 2023 OBJECTIVE: After limited root/ascending with or without hemiarch repair for acute type A aortic dissection (ATAAD), 20% to 30% of patients require distal reintervention, frequently for arch pathology. In this report, we describe an institutional algorithm ... Full text Link to item Cite

Effect of Tricuspid Repair on Pacemaker Rate After Mitral Repair Is Higher in Degenerative Disease.

Journal Article Ann Thorac Surg Short Rep · September 2023 BACKGROUND: Permanent pacemaker (PPM) placement after mitral valve (MV) repair is affected by concomitant procedures, yet existing literature reports conflicting rates. We aimed to characterize the effect of concomitant operation on risk of need for postop ... Full text Link to item Cite

Long-term outcomes of phenoclusters in severe tricuspid regurgitation.

Journal Article Eur Heart J · June 1, 2023 AIMS: Severe tricuspid regurgitation (TR) exhibits high 1-year morbidity and mortality, yet long-term cardiovascular risk overall and by subgroups remains unknown. This study characterizes 5-year outcomes and identifies distinct clinical risk profiles of s ... Full text Link to item Cite

Late Durability of Mitral Repair for Ischemic Versus Nonischemic Functional Mitral Regurgitation.

Journal Article Ann Thorac Surg · October 2022 BACKGROUND: Concerns regarding long-term durability of surgical repair for functional mitral regurgitation are based on short-term data, with few comparisons of ischemic mitral regurgitation (IMR) versus nonischemic functional mitral regurgitation (NIFMR) ... Full text Link to item Cite

Association Between Gabapentinoids and Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery.

Journal Article J Cardiothorac Vasc Anesth · August 2022 OBJECTIVE: Perioperative gabapentinoids in general surgery have been associated with an increased risk of postoperative pulmonary complications (PPCs), while resulting in equivocal pain relief. This study's aim was to examine the utilization of gabapentino ... Full text Link to item Cite

The outcome of mitral repair for degenerative versus ischemic mitral regurgitation using a single complete ring.

Journal Article J Card Surg · February 2022 BACKGROUND: The durability of surgical repair for degenerative versus ischemic mitral regurgitation (MR) is thought to be markedly different. We, therefore, examined late outcomes and durability for mitral repair in a large cohort of patients receiving a s ... Full text Link to item Cite

A single center experience with minimally invasive approaches in congenital cardiac surgery.

Journal Article J Thorac Dis · October 2021 BACKGROUND: Cardiac surgery is a technically demanding field with an appreciable learning curve that extends beyond formal training. Minimally invasive congenital cardiac surgery has one of the steepest learning curves. Early complications often discourage ... Full text Link to item Cite

Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

Conference Eur J Cardiothorac Surg · July 30, 2021 OBJECTIVES: The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proxima ... Full text Link to item Cite

Surgical risk scores: A roadmap to improved outcome?

Journal Article J Card Surg · July 2021 Habertheuer et al. present a risk scoring system for predicting morbidity and mortality in 1181 patients undergoing surgery for drug associated endocarditis. The authors conclude that drug-related endocarditis is associated with significant morbidity and m ... Full text Link to item Cite

Long-term outcomes of aortic root replacement for endocarditis.

Journal Article J Card Surg · June 2021 BACKGROUND: Infective endocarditis (IE) involving the aortic valve and root is associated with high risk requiring thoughtful surgical decision-making. The impact of valve and conduit choices and patient factors on long-term outcomes in this patient popula ... 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

Initial Medical Management of Acute Aortic Syndromes

Chapter · January 1, 2021 Acute aortic syndromes are part of a wide spectrum of arterial and aortic diseases. This life-threatening group of disorders requires rapid diagnosis and treatment to reduce the associated high mortality and morbidity. Regardless of whether definitive surg ... Full text Cite

Permissive Hypertension and Collateral Revascularization May Allow Avoidance of Cerebrospinal Fluid Drainage in Thoracic Endovascular Aortic Repair.

Journal Article Ann Thorac Surg · November 2020 BACKGROUND: The utility of cerebrospinal fluid drainage (CSFD) for prevention of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) remains unclear. We previously published our institutional algorithm restricting preoperative CSFD ... Full text Link to item Cite

Impact of dual energy cardiac CT for metal artefact reduction post aortic valve replacement.

Journal Article Eur J Radiol · August 2020 PURPOSE: Assess image quality of dual-energy (DE) and single-energy (SE) cardiac multi-detector computed tomographic (MDCT) post aortic valve replacement (AVR) on a dual source MDCT scanner. METHODS: Eighty patients with cardiac MDCT acquisitions (ECG gate ... Full text Link to item Cite

Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis.

Journal Article Am Heart J · June 2020 BACKGROUND: Patients with bicuspid aortic valve stenosis (BAV) were excluded from all the trileaflet aortic valve stenosis (TAV) pivotal trials, and therefore, their outcomes are not clearly defined. The aim of the study was to evaluate the outcomes of tra ... Full text Link to item Cite

Surgically implanted aortic valve bioprostheses deform after implantation: insights from computed tomography.

Journal Article Eur Radiol · May 2020 OBJECTIVE: Little is known about the prevalence and degree of deformation of surgically implanted aortic biological valve prostheses (bio-sAVRs). We assessed bio-sAVR deformation using multidetector-row computed tomography (MDCT). METHODS: Three imaging da ... Full text Link to item Cite

Use of left atrial appendage occlusion among older cardiac surgery patients with preoperative atrial fibrillation: a national cohort study.

Journal Article J Interv Card Electrophysiol · April 2020 PURPOSE: Patients with atrial fibrillation (AF) undergoing cardiac surgery are at substantially increased risk for stroke. Increasing evidence has suggested that surgical left atrial appendage occlusion (S-LAAO) may have the potential to substantially miti ... Full text Link to item Cite

Association of postoperative complications and outcomes following coronary artery bypass grafting.

Journal Article Am Heart J · April 2020 BACKGROUND: The long-term effects of postoperative complications following coronary artery bypass grafting (CABG) are unknown. METHODS: Medicare-linked records from the Society of Thoracic Surgeons Adult Cardiac Surgery Database were queried for isolated C ... Full text Link to item Cite

Review of alternative access in transcatheter aortic valve replacement.

Journal Article Cardiovasc Diagn Ther · February 2020 Transcatheter aortic valve replacement (TAVR) has surpassed surgical aortic valve replacement (SAVR) as the most common treatment strategy for severe symptomatic aortic stenosis over the past decade. As TAVR technology has continued to advance, it has been ... Full text Link to item Cite

Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement.

Journal Article J Invasive Cardiol · July 2019 BACKGROUND: Alternative access (AA) is still required for a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare the clinical outcomes of patients undergoing AA vs transfemoral (TF) access. METHO ... Link to item Cite

Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial.

Journal Article Anesthesiology · June 2019 BACKGROUND: Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. I ... Full text Open Access Link to item Cite

Three-factor prothrombin complex concentrates for refractory bleeding after cardiovascular surgery within an algorithmic approach to haemostasis.

Journal Article Vox Sang · May 2019 BACKGROUND/OBJECTIVES: Prothrombin complex concentrates (PCC) are increasingly administered off-label in the United States to treat bleeding in cardiovascular surgical patients and carry the potential risk for acquired thromboembolic side-effects after sur ... Full text Open Access Link to item Cite

Temporary autonomic modulation with botulinum toxin type A to reduce atrial fibrillation after cardiac surgery.

Journal Article Heart Rhythm · February 2019 BACKGROUND: Postoperative atrial fibrillation (POAF) frequently complicates cardiac surgery and is associated with worse outcomes. The cardiac autonomic nervous system is implicated in the pathogenesis of POAF. OBJECTIVE: The purpose of this study was to d ... Full text Link to item Cite

Longitudinal Changes in Regional Cerebral Perfusion and Cognition After Cardiac Operation.

Journal Article Ann Thorac Surg · January 2019 BACKGROUND: Cardiac operation has been associated with increased risk of postoperative cognitive decline, as well as dementia risk in the general population. Few studies, however, have examined the impact of coronary revascularization or valve replacement ... Full text Open Access Link to item Cite

Association of Renin-Angiotensin Inhibitor Treatment With Mortality and Heart Failure Readmission in Patients With Transcatheter Aortic Valve Replacement.

Journal Article JAMA · December 4, 2018 IMPORTANCE: Data are lacking on the effect of a renin-angiotensin system (RAS) inhibitor prescribed after transcatheter aortic valve replacement (TAVR). Treatment with a RAS inhibitor may reverse left ventricular remodeling and improve function. OBJECTIVE: ... Full text Link to item Cite

Invited Commentary: A Case of Multiple Ventricular Gradients.

Journal Article J Cardiothorac Vasc Anesth · August 2018 Full text Link to item Cite

Management Considerations in Infective Endocarditis: A Review.

Journal Article JAMA · July 3, 2018 IMPORTANCE: Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the le ... 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

Association Between Left Atrial Appendage Occlusion and Readmission for Thromboembolism Among Patients With Atrial Fibrillation Undergoing Concomitant Cardiac Surgery.

Journal Article JAMA · January 23, 2018 IMPORTANCE: The left atrial appendage is a key site of thrombus formation in atrial fibrillation (AF) and can be occluded or removed at the time of cardiac surgery. There is limited evidence regarding the effectiveness of surgical left atrial appendage occ ... Full text Link to item Cite

Outcomes of Reoperation After Acute Type A Aortic Dissection: Implications for Index Repair Strategy.

Conference J Am Heart Assoc · October 3, 2017 BACKGROUND: The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative s ... Full text Link to item Cite

Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.

Journal Article Anesth Analg · October 2017 BACKGROUND: Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated w ... Full text Open Access Link to item Cite

Assessment of Paravalvular Leak After Transcatheter Aortic Valve Replacement: Transesophageal Echocardiography Compared With Transthoracic Echocardiography.

Journal Article J Cardiothorac Vasc Anesth · August 2017 OBJECTIVES: Determine whether moderate or greater paravalvular leak (PVL) after transcatheter aortic valve replacement quantified using intraoperative transesophageal echocardiography (TEE) is associated with mortality and investigate the correlation betwe ... Full text Link to item Cite

Imaging Surveillance After Proximal Aortic Operations: Is it Necessary?

Journal Article Ann Thorac Surg · March 2017 BACKGROUND: Current guidelines for imaging surveillance after proximal aortic repair are not evidence based. This study sought to characterize the incidence and causes of reintervention after proximal aortic operations to provide data to guide the frequenc ... Full text Link to item Cite

Use of Adjuncts Reduces Cardiopulmonary Bypass Time During Minimally Invasive Aortic Valve Replacement.

Journal Article J Heart Valve Dis · March 2017 BACKGROUND: Minimally invasive aortic valve replacement (MIAVR) through a mini-thoracotomy is comparable to AVR through a sternotomy, but may have increased surgical times. The development of adjuncts such as the automatic knot fastener and percutaneous co ... Link to item Cite

Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.

Journal Article J Am Geriatr Soc · January 2017 OBJECTIVES: To look for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition, a common complication in seniors undergoing major surgery, using resting-state functional magnetic resonance imaging. DESIGN: Obj ... Full text Open Access Link to item Cite

In Reply.

Journal Article Anesthesiology · August 2016 Full text Link to item Cite

Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy.

Journal Article J Card Surg · August 2016 BACKGROUND: Systolic anterior motion (SAM) of the mitral valve, left ventricular outflow tract (LVOT) obstruction, and mitral regurgitation (MR) are known adverse outcomes that can occur after septal myectomy for hypertrophic obstructive cardiomyopathy. Th ... Full text Link to item Cite

Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes.

Journal Article Coron Artery Dis · June 2016 For patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), guideline recommendations and treatment pathways focus on revascularization for definitive treatment if the patient is an appropriate candidate. Despite the widespread use of ... Full text Link to item Cite

Valve-in-Valve Transcatheter Valve Implantation in the Nonaortic Position.

Journal Article J Card Surg · May 2016 BACKGROUND: Transcatheter valve-in-valve (VIV) procedures are an alternative to standard surgical valve replacement in high risk patients. METHODS: Cases in which a commercially approved transcatheter aortic valve replacement (TAVR) device was used for a n ... Full text Link to item Cite

The utility of the aortic dissection team: outcomes and insights after a decade of experience.

Journal Article Ann Cardiothorac Surg · May 2016 BACKGROUND: Mortality rates following acute type A aortic dissection (ATAAD) repair are reduced when operations are performed by a high-volume acute aortic dissection (AAD) team, leading to efforts to centralize ATAAD care. Here, we describe our experience ... Full text Link to item Cite

Use of human fibrinogen concentrate during proximal aortic reconstruction with deep hypothermic circulatory arrest.

Journal Article J Thorac Cardiovasc Surg · February 2016 OBJECTIVE: Human fibrinogen concentrate (HFC) is approved by the Food and Drug Administration for use at 70 mg/kg to treat congenital afibrinogenemia. We sought to determine whether this dose of HFC increases fibrinogen levels in the setting of high-risk b ... Full text Link to item Cite

Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

Journal Article Anesthesiology · February 2016 BACKGROUND: Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperat ... Full text Open Access Link to item Cite

Genome-wide association study of acute kidney injury after coronary bypass graft surgery identifies susceptibility loci.

Journal Article Kidney Int · October 2015 Acute kidney injury (AKI) is a common, serious complication of cardiac surgery. Since prior studies have supported a genetic basis for postoperative AKI, we conducted a genome-wide association study (GWAS) for AKI following coronary bypass graft (CABG) sur ... Full text Open Access Link to item Cite

Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study.

Journal Article Ann Thorac Surg · August 2015 BACKGROUND: The efficacy of conventional median sternotomy versus a right minithoracotomy (RT) approach to mitral valve surgery was evaluated in a single high-volume institution. METHODS: A retrospective analysis of a single institution's experience was pe ... Full text Open Access Link to item Cite

Bridge to long-term mechanical circulatory support with a left ventricular assist device: novel use of transcatheter aortic valve replacement.

Journal Article Ann Thorac Surg · April 2015 We describe the use of transcatheter aortic valve replacement to allow for bridging to a left ventricular assist device in a patient with end-stage heart failure, secondary to nonischemic cardiomyopathy and severe bioprosthetic aortic valve regurgitation. ... Full text Link to item Cite

Assessment of single-bolus contrast administration technique using hybrid dual-source ECG-gated thoracic and dual-source non-ECG-gated high-pitch abdominopelvic CT acquisitions for procedural planning before transcatheter aortic valve replacement.

Journal Article J Comput Assist Tomogr · 2015 PURPOSE: This study aimed to assess vascular contrast opacification and homogeneity using single-bolus contrast administration with hybrid thoracic and abdominopelvic computed tomographic angiography in patients with severe aortic valve stenosis. MATERIALS ... Full text Link to item Cite

Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis.

Journal Article J Thorac Cardiovasc Surg · December 2014 OBJECTIVE: The choice of cerebral perfusion strategy for aortic arch surgery has been debated, and the superiority of antegrade (ACP) or retrograde (RCP) cerebral perfusion has not been shown. We examined the early and late outcomes for ACP versus RCP in p ... Full text Link to item Cite

Sternal talon offers a solution for secondary sternum osteosynthesis in patients with nonunion.

Journal Article Ann Thorac Surg · November 2014 BACKGROUND: Median sternotomy may be associated with postoperative complications such as nonunion after conventional metal wire closure. The Sternal Talon device (KLS Martin, Jacksonville, FL) has recently been introduced as an alternative for osteosynthes ... Full text Link to item Cite

G protein-coupled receptor kinase 5 gene polymorphisms are associated with postoperative atrial fibrillation after coronary artery bypass grafting in patients receiving β-blockers.

Other Circ Cardiovasc Genet · October 2014 BACKGROUND: We hypothesized that genetic variations in the adrenergic signaling pathway and cytochrome P450 2D6 enzyme are associated with new-onset atrial fibrillation (AF) in patients who underwent coronary artery bypass grafting and were treated with pe ... Full text Link to item Cite

Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program.

Journal Article J Am Coll Cardiol · May 6, 2014 OBJECTIVES: The purpose of this study was to compare the results of acute type A aortic dissection (ATAAD) repair before and after implementation of a multidisciplinary thoracic aortic surgery program (TASP) at our institution, with dedicated high-volume t ... Full text Link to item Cite

Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting.

Journal Article Ann Cardiothorac Surg · May 2014 BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for chronic type B aortic dissection (CTBAD) at our institution. However, it remains incapable of treating all patients with CTBAD. The present study aims to review ... Full text Link to item Cite

Risk-adjusted survival after tissue versus mechanical aortic valve replacement: a 23-year assessment.

Journal Article J Heart Valve Dis · November 2013 BACKGROUND AND AIM OF THE STUDY: Detailed analyses of risk-adjusted outcomes after mitral valve surgery have documented significant survival decrements with tissue valves at any age. Several recent studies of prosthetic aortic valve replacement (AVR) also ... Link to item Cite

Twenty-five-year outcomes after multiple internal thoracic artery bypass.

Journal Article J Thorac Cardiovasc Surg · April 2013 OBJECTIVE: Coronary artery bypass grafting with multiple internal thoracic artery grafts is currently controversial. This study assessed single institutional outcomes with multiple internal thoracic artery grafting for guidance with future clinical decisio ... Full text Link to item Cite

The association of postcardiac surgery acute kidney injury with intraoperative systolic blood pressure hypotension.

Journal Article Anesthesiol Res Pract · 2013 Background. Postoperative acute kidney injury (AKI) is associated with high mortality and substantial cost after aortocoronary bypass graft (CABG) surgery. We tested the hypothesis that intraoperative systolic blood pressure variation is associated with po ... Full text Open Access Link to item Cite

Mitral valve repair for ischemic mitral regurgitation: review of current techniques.

Journal Article Heart Lung Vessel · 2013 INTRODUCTION: Ischemic mitral regurgitation can be defined as moderate to severe mitral leak precipitated by acute myocardial infarction. Valve repair is now the procedure of choice, but some cases can pose difficult anatomy. This review will illustrate cu ... Link to item Cite

Minithoracotomy versus sternotomy for mitral surgery in patients with chronic renal impairment: a propensity-matched study.

Journal Article Innovations (Phila) · 2013 OBJECTIVE: Compared with median sternotomy, a right thoracotomy (RT) approach to mitral surgery is associated with decreased postoperative acute renal failure. Therefore, we examined propensity-matched patients with chronic renal impairment to compare outc ... Full text Link to item Cite

Effects of institutional volumes on operative outcomes for aortic root replacement in North America.

Journal Article J Thorac Cardiovasc Surg · January 2013 OBJECTIVES: Hospital procedure volume has been strongly associated with postoperative mortality for a number of complex cardiovascular procedures. Although not yet described, a similar relationship might be expected for surgical procedures involving the ao ... Full text Link to item Cite

Insurance status predicts non-elective case status but not outcomes of thoracic aortic operations

Conference Journal of the American College of Surgeons · September 2012 Full text Cite

Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.

Journal Article Ann Thorac Surg · June 2012 BACKGROUND: Numerous studies have supported the effectiveness of recombinant activated factor VII (rFVIIa) for the control of bleeding after cardiac procedures; however safety concerns persist. Here we report the novel use of intraoperative low-dose rFVIIa ... Full text Link to item Cite

Thoracoabdominal aortic aneurysms

Chapter · January 18, 2012 Cite

Pilot study of sternal plating for primary closure of the sternum in cardiac surgical patients.

Journal Article Innovations (Phila) · November 2011 OBJECTIVE: Postoperative sternal wound complications are a significant problem in high-risk patients. In addition to closure with conventional wires, several systems involving rigid fixation with metal plates are currently available. The rapid sternal clos ... Full text Link to item Cite

Techniques of aortic valve repair.

Journal Article Innovations (Phila) · November 2011 Similar to mitral repair, newer methods of aortic valve reconstruction are achieving excellent outcomes with an 85% to 90% freedom from valve-related complications at 10 years. The goal of this review is to illustrate these newer and more stable techniques ... Full text Link to item Cite

Results of proximal arch replacement using deep hypothermia for circulatory arrest: is moderate hypothermia really justifiable?

Journal Article Am Surg · November 2011 The use of selective cerebral perfusion with warmer temperatures during circulatory arrest has been increasingly used for arch replacement over concerns regarding the safety of deep hypothermic circulatory arrest (DHCA). However, little data actually exist ... Link to item Cite

Increasing mitral valve repair rates with nonresectional techniques.

Journal Article Innovations (Phila) · July 2011 In every common mitral pathology studied to date, repairing the patient's own diseased valve to adequate function has yielded superior long-term results as compared with prosthetic valve replacement with either tissue or mechanical devices. Thus, increasin ... Full text Link to item Cite

Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery.

Journal Article Ann Thorac Surg · June 2011 BACKGROUND: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow gra ... Full text Link to item Cite

Outcomes for endocarditis surgery in North America: a simplified risk scoring system.

Journal Article J Thorac Cardiovasc Surg · January 2011 OBJECTIVE: Operation for infective endocarditis is associated with the highest mortality of any valve disease, with overall rates of in-hospital mortality exceeding 20%. The Society of Thoracic Surgeons Adult Cardiac Surgery Database was examined to develo ... Full text Link to item Cite

Arterial bypass grafting of the coronary circulation.

Journal Article HSR Proc Intensive Care Cardiovasc Anesth · 2011 Surgical coronary bypass has evolved continually, and recent developments favor performing coronary grafts with all-arterial conduits in order to obtain better long-term graft patencies. With bilateral internal mammary artery grafts and both radial arterie ... Link to item Cite

Intraoperative systolic blood pressure variability predicts 30-day mortality in aortocoronary bypass surgery patients.

Journal Article Anesthesiology · August 2010 BACKGROUND: Few data support an association between blood pressure variability and clinical outcomes during cardiac surgery. We tested the hypothesis that intraoperative systolic blood pressure variability outside a targeted blood pressure range predicts 3 ... Full text Link to item Cite

Cognitive function after major noncardiac surgery, apolipoprotein E4 genotype, and biomarkers of brain injury.

Other Anesthesiology · April 2010 BACKGROUND: Postoperative cognitive dysfunction (POCD) is a significant cause of morbidity after noncardiac surgery. Identified risk factors are largely limited to demographic characteristics. We hypothesized that POCD was associated with apolipoprotein E4 ... Full text Link to item Cite

Pulse pressure and long-term survival after coronary artery bypass graft surgery.

Journal Article Anesth Analg · February 1, 2010 BACKGROUND: Data from longitudinal studies reveal that widened pulse pressure (PP) is a major predictor of coronary heart disease and mortality, but it is unknown whether PP similarly decreases survival after coronary artery bypass graft (CABG) surgery for ... Full text Link to item Cite

Two-stage total cardioaortic replacement for end-stage heart and aortic disease in Marfan syndrome: case report and review of the literature.

Journal Article J Heart Lung Transplant · September 2009 A 24-year-old man with Marfan syndrome underwent mitral valve repair for prolapse at age 13. He sustained an acute type A aortic dissection at age 20 and underwent aortic root/ascending aortic replacement with a mechanical valved conduit. He initially did ... Full text Link to item Cite

Laser-assisted extraction of pacemaker and defibrillator leads: the role of the cardiac surgeon.

Journal Article Ann Thorac Surg · May 2009 BACKGROUND: The development of laser-assisted extraction techniques for chronically implanted pacemaker and defibrillator leads has reduced the need for open surgical removal. Reports of the mortality from laser-assisted extraction range from 1.9% to 3.4%. ... Full text Link to item Cite

Prolonged function of macrophage, von Willebrand factor-deficient porcine pulmonary xenografts.

Journal Article Am J Transplant · January 2007 Porcine von Willebrand factor (vWF) activates human and primate platelets. Having determined the importance of pulmonary intravascular macrophages (PIMs) in pulmonary xenotransplantation, we evaluated whether, in the absence of PIMs, vWF might play a role ... Full text Link to item Cite

Effect of an anti-C5a monoclonal antibody indicates a prominent role for anaphylatoxin in pulmonary xenograft dysfunction.

Journal Article Transplantation · June 27, 2006 BACKGROUND: In contrast to renal or cardiac xenografts, the inhibition of complement using cobra venom factor (CVF) accelerates pulmonary xenograft failure. By activating C3/C5 convertase, CVF depletes complement while additionally generating C5a and other ... Full text Link to item Cite

Depletion of pulmonary intravascular macrophages prevents hyperacute pulmonary xenograft dysfunction.

Journal Article Transplantation · April 27, 2006 BACKGROUND: Recent years have brought dramatic progress in the field of xenotransplantation, with the development of transgenic swine and various other means of overcoming the rejection mediated by xenoreactive antibodies. Although progress has been rapid ... Full text Link to item Cite

Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma.

Journal Article Ann Surg Oncol · March 2006 BACKGROUND: The incidence of carcinoma of the gastroesophageal junction (GEJ) is rapidly increasing, and the prognosis remains poor. We examined outcomes in patients who received neoadjuvant chemoradiation for GEJ tumors to identify factors that predict di ... Full text Link to item Cite

Oral feeding with pig peripheral lymphocytes decreases the xenogeneic delayed type hypersensitivity reaction in galactosyltransferase knockout mice.

Journal Article Transplant Proc · October 2005 PURPOSE: Oral tolerance induction has shown promising results in experimental allotransplantation models but is not well investigated in xenotransplantation. We investigated the possibility to induce tolerance against pig peripheral lymphocytes (pPBL) in g ... Full text Link to item Cite

Reduction of vascular intimal-medial hyperplasia in polytetrafluoroethylene arteriovenous grafts via expression of an inhibitor of G protein signaling.

Journal Article Ann Vasc Surg · September 2005 Polytetrafluoroethylene (PTFE) arteriovenous (AV) grafts are performed routinely for vascular access. The limited life span of PTFE grafts is a major cause of morbidity. Graft failure is attributed to venous outflow tract vascular smooth muscle (VSM) hyper ... Full text Link to item Cite

Prevention of acute lung injury in swine: depletion of pulmonary intravascular macrophages using liposomal clodronate.

Journal Article J Surg Res · June 1, 2003 BACKGROUND: Swine contain large numbers of pulmonary intravascular macrophages (PIMs) that mediate the physiological response observed in acute lung injury (ALI). As the hyperacute dysfunction observed in pulmonary xenotransplantation is similar to endotox ... Full text Link to item Cite

A porcine model of intimal-medial hyperplasia in polytetrafluoroethylene arteriovenous grafts.

Journal Article J Vasc Access · 2003 PURPOSE: Vascular access polytetrafluoroethylene (PTFE) graft failure is a major cause of morbidity in the hemodialysis population. The most common cause of graft failure is thrombosis secondary to stenosis at the venous outflow tract. Venous outflow steno ... Link to item Cite

The role of the porcine von Willebrand factor: baboon platelet interactions in pulmonary xenotransplantation.

Journal Article Transplantation · December 15, 2002 BACKGROUND: Porcine von Willebrand factor (pvWF) has been shown to bind to human glycoprotein Ib (GPIb) and cause activation of human (or primate) platelets in the absence of shear stress. Pulmonary xenografts develop disseminated intravascular coagulation ... Full text Link to item Cite

Laparoscopic antireflux surgery in the lung transplant population.

Journal Article Surg Endosc · December 2002 BACKGROUND: Lung transplantation has emerged as a viable therapeutic option for patients with a variety of end-stage pulmonary diseases. As immediate posttransplant surgical outcomes have improved, the greatest limitation of lung transplantation remains ch ... Full text Link to item Cite

Disseminated intravascular coagulation in association with pig-to-primate pulmonary xenotransplantation.

Journal Article Transplantation · June 15, 2002 BACKGROUND: Profound coagulopathy has been proposed as a barrier to xenotransplantation. Disseminated intravascular coagulation (DIC) has been observed with the rejection of renal and bone marrow xenografts but has not yet been described in pulmonary xenog ... Full text Link to item Cite

Non-anti-Gal alpha1-3Gal antibody mechanisms are sufficient to cause hyperacute lung dysfunction in pulmonary xenotransplantation.

Journal Article J Am Coll Surg · June 2002 BACKGROUND: Hyperacute lung dysfunction, which is always associated with pulmonary pig-to-primate xenotransplantation is not well understood. The mechanisms associated with its occurrence seem to differ from mechanisms involved in hyperacute xenograft reje ... Full text Link to item Cite

Binding of polyreactive antibodies to self versus foreign antigens.

Journal Article Immunobiology · March 2002 Aside from their ability to bind to multiple antigens, the classic hallmark of polyreactive antibodies is their autoreactivity. Because of their ability to bind a number of common autoantigens, it has long been speculated that polyreactive antibodies are i ... Full text Link to item Cite

Evidence for polyreactive xenoreactive antibodies in the repertoire of human anti-swine antibodies: the 'next' humoral barrier to xenotransplantation?

Journal Article Transpl Immunol · October 2001 The xenoreactive nature of anti-Galalpha1-3Gal antibodies, and to a lesser extent, polyreactive antibodies, has been characterized by a number of investigators. With the advent of therapies that avoid hyperacute xenograft rejection due to anti-Galalpha1-3G ... Full text Link to item Cite