Hossein Almassi - Academia.edu (original) (raw)

Papers by Hossein Almassi

Research paper thumbnail of Editorial review: guidance for future atrial fibrillation research

Vessel plus, May 20, 2024

The following is a brief review and commentary covering the content of the Special Issue of Vesse... more The following is a brief review and commentary covering the content of the Special Issue of Vessel Plus entitled Current state of knowledge: Atrial Fibrillation and Cardiac Surgery. All articles in this issue are highlighted with a brief comment for the busy reader, the idea being to facilitate and encourage reading of the original work.

Research paper thumbnail of Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation?

Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2023

Research paper thumbnail of A Unique Hybrid Approach to the Treatment of an Aberrant Right Subclavian Artery Aneurysm

Vascular and Endovascular Surgery, Nov 8, 2012

Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneu... more Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneurysmal. The ARSAs are often asymptomatic but aneurysms arising in this location are potentially lethal. Due to the high morbidity and mortality rates associated with the traditional open repair methods, less invasive endovascular methods are becoming more popular. This is a case describing a unique hybrid repair of an aneurysmal ARSA in an asymptomatic male.

Research paper thumbnail of Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: A report from the Randomized On Versus Off Bypass trial

The Journal of Thoracic and Cardiovascular Surgery, 2012

The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) i... more The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) in patients randomized to conventional coronary artery bypass graft (on-pump coronary artery bypass [ONCAB]) versus beating heart coronary surgery (off-pump coronary artery bypass [OPCAB]). Methods: The subgroup of 2103 patients (of 2203 enrollees) in the Randomized On Versus Off Bypass trial with no POAF was studied (1056 patients in the ONCAB group and 1047 patients in the OPCAB group). Univariate and multivariate analyses were used to identify the predictors of POAF and the impact of POAF on outcomes.

Research paper thumbnail of Stroke risk and anticoagulation in the setting of post-cardiac surgery atrial fibrillation: a systematic review of the literature

Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery... more Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery. It remains unclear to what extent POAF increases the stroke risk and whether anticoagulation is warranted in this setting. The primary objective of this review was to conduct a systematic review of the evidence for a correlation between POAF and stroke. Further, we sought to evaluate the published evidence on anticoagulation in the setting of POAF to prevent stroke. To this end, we performed a comprehensive literature search to identify studies on POAF in patients undergoing cardiac surgery with stroke as an outcome. To date, eight meta-analyses providing pooled estimates of the stroke risk associated with POAF in patients undergoing cardiac surgery have been published. The reported pooled odds ratios range from 1.36 to 4.09 for unadjusted estimates. Additionally, five studies were identified that evaluated the impact of anticoagulation on stroke in the setting of POAF. Of these, three supported the use of anticoagulants, and two studies were inconclusive. This systematic review did not find strong supporting evidence that POAF is causally related to stroke, despite a strong correlation with comorbidities and all-cause mortality in the literature. Available evidence to date suggests an elevated risk of bleeding with no clear reduction in stroke or other thromboembolic events when anticoagulation is initiated in the setting of POAF. An upcoming randomized clinical trial by the Cardiothoracic Surgery Network group will hopefully provide clarification on the recommendations for anticoagulation in the setting of POAF after cardiac surgery.

Research paper thumbnail of A Highly Mobile Mass in the Anterior Left Ventricular Outflow Tract Immediately Beneath a Heavily Calcified, Stenotic Aortic Valve: Vegetation, Thrombus, or Neoplasm?

Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2015

Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zd... more Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zdanovec MD, Brittany N. Price PA-C, Carlos O. Encarnácion MD, Minerva P. Kryniak MD, G. Hossein Almassi MD, A highly mobile mass in the anterior left ventricular outflow tract immediately beneath a heavily calcified, stenotic aortic valve: Vegetation, thrombus, or neoplasm?, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2015.04.028

Research paper thumbnail of Comparative in vitro antimicrobial activity of a novel quinolone, garenoxacin, against aerobic and anaerobic microbial isolates recovered from general, vascular, cardiothoracic and otolaryngologic surgical patients

Journal of Antimicrobial Chemotherapy, Sep 26, 2005

To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusio... more To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusion breakpoints. Methods: The in vitro susceptibilities of 2137 bacterial isolates, representing 28 different species, to doripenem, imipenem and meropenem were determined by the NCCLS broth microdilution and disc diffusion testing methods. Results: The doripenem MIC 50 s/ 90 s were (in mg/L) for Enterobacteriaceae, 0.06/0.25; Pseudomonas aeruginosa, 0.25/1; Haemophilus influenzae, 0.12/0.5; streptococci, 0.016/0.5 and for staphylococci, 0.06/4. Like other carbapenems tested, doripenem MIC 50 s/ 90 s were >32/>32 and 0.5/32 mg/L for the enterococci and non-fermentative Gram-negative bacilli (excluding P. aeruginosa), respectively. Against members of the Enterobacteriaceae and H. influenzae, doripenem was generally more active than imipenem and the same as or slightly less active than meropenem. Values for the non-fermentative Gram-negative bacilli excluding P. aeruginosa were comparable for all three carbapenems. Doripenem MICs increased with increasing resistance to methicillin (staphylococci), penicillin (streptococci) and strains that were b-lactamase-negative ampicillin-resistant (Haemophilus). Doripenem exhibits excellent activity against extended-spectrum b-lactamase-producing strains of Escherichia coli and Klebsiella spp. The NCCLS disc diffusion test was performed simultaneously on all organisms. Conclusions: Assuming the MIC susceptible breakpoints for doripenem are < _ 1 mg/L for the streptococci and < _ 2 mg/L for all other genera, then disc diffusion zone diameter breakpoints can be proposed. In addition, MIC and/or disc diffusion quality control ranges of doripenem were determined for 10 ATCC reference strains.

Research paper thumbnail of Cardiovascular risk in patients without known cardiovascular disease

PubMed, 2014

Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient... more Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Multiple risk models have been validated in large patient populations and provide insights into the risks associated with CVD. When assessing such risks, we suggest using a model that predicts myocardial infarction, cardiovascular death, and/or cerebrovascular events. In this review, we analyze several risk models and stratify the risks associated with CVD. We suggest that appropriate profiling of patients at-risk of CVD will lead to better physician recognition and treatment of modifiable risk factors, appropriate application of ATP III treatment for hyperlipidemia, and achieving optimal blood pressure control.

Research paper thumbnail of A victory for all Halstedians: Evidence supporting cardiac surgical residents training

The Journal of Thoracic and Cardiovascular Surgery, Apr 1, 2016

Research paper thumbnail of Mortality and neurologic morbidity after repair of traumatic aortic disruption

The Annals of Thoracic Surgery, Mar 1, 1996

Background. Traumatic disruption of the thoracic aorta frequently results in death before operati... more Background. Traumatic disruption of the thoracic aorta frequently results in death before operative repair. The determinants of mortality after repair, however, are uncertain. In addition, intraoperative strategies for reducing the incidence of spinal cord injury remain controversial. Methods. The records of 45 consecutive patients under

Research paper thumbnail of Blood flow velocity of internal mammary artery and saphenous vein grafts to the coronary arteries

Journal of Surgical Research, Apr 1, 1988

Doppler-derived blood flow velocity measurements were used to characterize the hemodynamics of 66... more Doppler-derived blood flow velocity measurements were used to characterize the hemodynamics of 66 internal mammary artery grafts and 60 saphenous vein grafts to the coronary arteries at operation. Pulsed Doppler spectral analysis of centerstream graft flow demonstrated predominantly diastolic flow with a variable, multiphasic flow pattern in systole. The magnitude and configuration of the graft flow velocity waveform varied with graft type and whether the runoff was to single or multiple arteries. At operation, peak diastolic flow velocity was greater (P less than 0.0001) in internal mammary artery grafts to a single outflow artery (71 +/- 2 cm/sec) compared with single vein grafts (31 +/- 4 cm/sec). Sequential grafts demonstrated increased flow velocity and forward flow throughout the pulse cycle, indicative of low outflow resistance. Analysis of the phasic flow patterns permitted an assessment of functional graft patency. Technical errors (anastomotic stricture, internal mammary pedicle torsion) were identified in three grafts with low or absent diastolic flow. Vasospasm of the internal mammary artery was associated with high flow velocity throughout the pulse cycle. Observed differences in patency and the development of intimal hyperplasia between internal mammary artery and saphenous vein grafts may be related to graft hemodynamics.

Research paper thumbnail of Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation?

Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2023

Research paper thumbnail of A Unique Hybrid Approach to the Treatment of an Aberrant Right Subclavian Artery Aneurysm

Vascular and Endovascular Surgery, Nov 8, 2012

Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneu... more Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneurysmal. The ARSAs are often asymptomatic but aneurysms arising in this location are potentially lethal. Due to the high morbidity and mortality rates associated with the traditional open repair methods, less invasive endovascular methods are becoming more popular. This is a case describing a unique hybrid repair of an aneurysmal ARSA in an asymptomatic male.

Research paper thumbnail of Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: A report from the Randomized On Versus Off Bypass trial

The Journal of Thoracic and Cardiovascular Surgery, 2012

The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) i... more The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) in patients randomized to conventional coronary artery bypass graft (on-pump coronary artery bypass [ONCAB]) versus beating heart coronary surgery (off-pump coronary artery bypass [OPCAB]). Methods: The subgroup of 2103 patients (of 2203 enrollees) in the Randomized On Versus Off Bypass trial with no POAF was studied (1056 patients in the ONCAB group and 1047 patients in the OPCAB group). Univariate and multivariate analyses were used to identify the predictors of POAF and the impact of POAF on outcomes.

Research paper thumbnail of Stroke risk and anticoagulation in the setting of post-cardiac surgery atrial fibrillation: a systematic review of the literature

Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery... more Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery. It remains unclear to what extent POAF increases the stroke risk and whether anticoagulation is warranted in this setting. The primary objective of this review was to conduct a systematic review of the evidence for a correlation between POAF and stroke. Further, we sought to evaluate the published evidence on anticoagulation in the setting of POAF to prevent stroke. To this end, we performed a comprehensive literature search to identify studies on POAF in patients undergoing cardiac surgery with stroke as an outcome. To date, eight meta-analyses providing pooled estimates of the stroke risk associated with POAF in patients undergoing cardiac surgery have been published. The reported pooled odds ratios range from 1.36 to 4.09 for unadjusted estimates. Additionally, five studies were identified that evaluated the impact of anticoagulation on stroke in the setting of POAF. Of these, three supported the use of anticoagulants, and two studies were inconclusive. This systematic review did not find strong supporting evidence that POAF is causally related to stroke, despite a strong correlation with comorbidities and all-cause mortality in the literature. Available evidence to date suggests an elevated risk of bleeding with no clear reduction in stroke or other thromboembolic events when anticoagulation is initiated in the setting of POAF. An upcoming randomized clinical trial by the Cardiothoracic Surgery Network group will hopefully provide clarification on the recommendations for anticoagulation in the setting of POAF after cardiac surgery.

Research paper thumbnail of A Highly Mobile Mass in the Anterior Left Ventricular Outflow Tract Immediately Beneath a Heavily Calcified, Stenotic Aortic Valve: Vegetation, Thrombus, or Neoplasm?

Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2015

Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zd... more Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zdanovec MD, Brittany N. Price PA-C, Carlos O. Encarnácion MD, Minerva P. Kryniak MD, G. Hossein Almassi MD, A highly mobile mass in the anterior left ventricular outflow tract immediately beneath a heavily calcified, stenotic aortic valve: Vegetation, thrombus, or neoplasm?, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2015.04.028

Research paper thumbnail of Comparative in vitro antimicrobial activity of a novel quinolone, garenoxacin, against aerobic and anaerobic microbial isolates recovered from general, vascular, cardiothoracic and otolaryngologic surgical patients

Journal of Antimicrobial Chemotherapy, Sep 26, 2005

To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusio... more To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusion breakpoints. Methods: The in vitro susceptibilities of 2137 bacterial isolates, representing 28 different species, to doripenem, imipenem and meropenem were determined by the NCCLS broth microdilution and disc diffusion testing methods. Results: The doripenem MIC 50 s/ 90 s were (in mg/L) for Enterobacteriaceae, 0.06/0.25; Pseudomonas aeruginosa, 0.25/1; Haemophilus influenzae, 0.12/0.5; streptococci, 0.016/0.5 and for staphylococci, 0.06/4. Like other carbapenems tested, doripenem MIC 50 s/ 90 s were >32/>32 and 0.5/32 mg/L for the enterococci and non-fermentative Gram-negative bacilli (excluding P. aeruginosa), respectively. Against members of the Enterobacteriaceae and H. influenzae, doripenem was generally more active than imipenem and the same as or slightly less active than meropenem. Values for the non-fermentative Gram-negative bacilli excluding P. aeruginosa were comparable for all three carbapenems. Doripenem MICs increased with increasing resistance to methicillin (staphylococci), penicillin (streptococci) and strains that were b-lactamase-negative ampicillin-resistant (Haemophilus). Doripenem exhibits excellent activity against extended-spectrum b-lactamase-producing strains of Escherichia coli and Klebsiella spp. The NCCLS disc diffusion test was performed simultaneously on all organisms. Conclusions: Assuming the MIC susceptible breakpoints for doripenem are < _ 1 mg/L for the streptococci and < _ 2 mg/L for all other genera, then disc diffusion zone diameter breakpoints can be proposed. In addition, MIC and/or disc diffusion quality control ranges of doripenem were determined for 10 ATCC reference strains.

Research paper thumbnail of Mesoatrial shunting for portal decompression in alcoholic cirrhosis

PubMed, Mar 1, 1986

A 36-year-old Chinese man with alcoholic cirrhosis presented to hospital with exsanguinating vari... more A 36-year-old Chinese man with alcoholic cirrhosis presented to hospital with exsanguinating variceal hemorrhage. Conventional porta-systemic decompressive operations could not be done because of dense vascular adhesions from two previous operations and a sub-hepatic abcess. A mesenteric-to-right-atrial shunt was done with successful control of hemorrhage and reduction of portal pressure. Long-term follow-up reveals no further bleeding and a return to full-time employment. We conclude that mesoatrial shunting is a useful alternative procedure for portasystemic decompression in alcoholic cirrhosis, although one which will be needed only in unusual circumstances.

Research paper thumbnail of A case of transdiaphragmatic wound of the heart repaired through the abdomen

Research paper thumbnail of Cardiovascular risk in patients without known cardiovascular disease

PubMed, 2014

Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient... more Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Multiple risk models have been validated in large patient populations and provide insights into the risks associated with CVD. When assessing such risks, we suggest using a model that predicts myocardial infarction, cardiovascular death, and/or cerebrovascular events. In this review, we analyze several risk models and stratify the risks associated with CVD. We suggest that appropriate profiling of patients at-risk of CVD will lead to better physician recognition and treatment of modifiable risk factors, appropriate application of ATP III treatment for hyperlipidemia, and achieving optimal blood pressure control.

Research paper thumbnail of Editorial review: guidance for future atrial fibrillation research

Vessel plus, May 20, 2024

The following is a brief review and commentary covering the content of the Special Issue of Vesse... more The following is a brief review and commentary covering the content of the Special Issue of Vessel Plus entitled Current state of knowledge: Atrial Fibrillation and Cardiac Surgery. All articles in this issue are highlighted with a brief comment for the busy reader, the idea being to facilitate and encourage reading of the original work.

Research paper thumbnail of Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation?

Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2023

Research paper thumbnail of A Unique Hybrid Approach to the Treatment of an Aberrant Right Subclavian Artery Aneurysm

Vascular and Endovascular Surgery, Nov 8, 2012

Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneu... more Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneurysmal. The ARSAs are often asymptomatic but aneurysms arising in this location are potentially lethal. Due to the high morbidity and mortality rates associated with the traditional open repair methods, less invasive endovascular methods are becoming more popular. This is a case describing a unique hybrid repair of an aneurysmal ARSA in an asymptomatic male.

Research paper thumbnail of Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: A report from the Randomized On Versus Off Bypass trial

The Journal of Thoracic and Cardiovascular Surgery, 2012

The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) i... more The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) in patients randomized to conventional coronary artery bypass graft (on-pump coronary artery bypass [ONCAB]) versus beating heart coronary surgery (off-pump coronary artery bypass [OPCAB]). Methods: The subgroup of 2103 patients (of 2203 enrollees) in the Randomized On Versus Off Bypass trial with no POAF was studied (1056 patients in the ONCAB group and 1047 patients in the OPCAB group). Univariate and multivariate analyses were used to identify the predictors of POAF and the impact of POAF on outcomes.

Research paper thumbnail of Stroke risk and anticoagulation in the setting of post-cardiac surgery atrial fibrillation: a systematic review of the literature

Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery... more Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery. It remains unclear to what extent POAF increases the stroke risk and whether anticoagulation is warranted in this setting. The primary objective of this review was to conduct a systematic review of the evidence for a correlation between POAF and stroke. Further, we sought to evaluate the published evidence on anticoagulation in the setting of POAF to prevent stroke. To this end, we performed a comprehensive literature search to identify studies on POAF in patients undergoing cardiac surgery with stroke as an outcome. To date, eight meta-analyses providing pooled estimates of the stroke risk associated with POAF in patients undergoing cardiac surgery have been published. The reported pooled odds ratios range from 1.36 to 4.09 for unadjusted estimates. Additionally, five studies were identified that evaluated the impact of anticoagulation on stroke in the setting of POAF. Of these, three supported the use of anticoagulants, and two studies were inconclusive. This systematic review did not find strong supporting evidence that POAF is causally related to stroke, despite a strong correlation with comorbidities and all-cause mortality in the literature. Available evidence to date suggests an elevated risk of bleeding with no clear reduction in stroke or other thromboembolic events when anticoagulation is initiated in the setting of POAF. An upcoming randomized clinical trial by the Cardiothoracic Surgery Network group will hopefully provide clarification on the recommendations for anticoagulation in the setting of POAF after cardiac surgery.

Research paper thumbnail of A Highly Mobile Mass in the Anterior Left Ventricular Outflow Tract Immediately Beneath a Heavily Calcified, Stenotic Aortic Valve: Vegetation, Thrombus, or Neoplasm?

Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2015

Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zd... more Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zdanovec MD, Brittany N. Price PA-C, Carlos O. Encarnácion MD, Minerva P. Kryniak MD, G. Hossein Almassi MD, A highly mobile mass in the anterior left ventricular outflow tract immediately beneath a heavily calcified, stenotic aortic valve: Vegetation, thrombus, or neoplasm?, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2015.04.028

Research paper thumbnail of Comparative in vitro antimicrobial activity of a novel quinolone, garenoxacin, against aerobic and anaerobic microbial isolates recovered from general, vascular, cardiothoracic and otolaryngologic surgical patients

Journal of Antimicrobial Chemotherapy, Sep 26, 2005

To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusio... more To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusion breakpoints. Methods: The in vitro susceptibilities of 2137 bacterial isolates, representing 28 different species, to doripenem, imipenem and meropenem were determined by the NCCLS broth microdilution and disc diffusion testing methods. Results: The doripenem MIC 50 s/ 90 s were (in mg/L) for Enterobacteriaceae, 0.06/0.25; Pseudomonas aeruginosa, 0.25/1; Haemophilus influenzae, 0.12/0.5; streptococci, 0.016/0.5 and for staphylococci, 0.06/4. Like other carbapenems tested, doripenem MIC 50 s/ 90 s were >32/>32 and 0.5/32 mg/L for the enterococci and non-fermentative Gram-negative bacilli (excluding P. aeruginosa), respectively. Against members of the Enterobacteriaceae and H. influenzae, doripenem was generally more active than imipenem and the same as or slightly less active than meropenem. Values for the non-fermentative Gram-negative bacilli excluding P. aeruginosa were comparable for all three carbapenems. Doripenem MICs increased with increasing resistance to methicillin (staphylococci), penicillin (streptococci) and strains that were b-lactamase-negative ampicillin-resistant (Haemophilus). Doripenem exhibits excellent activity against extended-spectrum b-lactamase-producing strains of Escherichia coli and Klebsiella spp. The NCCLS disc diffusion test was performed simultaneously on all organisms. Conclusions: Assuming the MIC susceptible breakpoints for doripenem are < _ 1 mg/L for the streptococci and < _ 2 mg/L for all other genera, then disc diffusion zone diameter breakpoints can be proposed. In addition, MIC and/or disc diffusion quality control ranges of doripenem were determined for 10 ATCC reference strains.

Research paper thumbnail of Cardiovascular risk in patients without known cardiovascular disease

PubMed, 2014

Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient... more Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Multiple risk models have been validated in large patient populations and provide insights into the risks associated with CVD. When assessing such risks, we suggest using a model that predicts myocardial infarction, cardiovascular death, and/or cerebrovascular events. In this review, we analyze several risk models and stratify the risks associated with CVD. We suggest that appropriate profiling of patients at-risk of CVD will lead to better physician recognition and treatment of modifiable risk factors, appropriate application of ATP III treatment for hyperlipidemia, and achieving optimal blood pressure control.

Research paper thumbnail of A victory for all Halstedians: Evidence supporting cardiac surgical residents training

The Journal of Thoracic and Cardiovascular Surgery, Apr 1, 2016

Research paper thumbnail of Mortality and neurologic morbidity after repair of traumatic aortic disruption

The Annals of Thoracic Surgery, Mar 1, 1996

Background. Traumatic disruption of the thoracic aorta frequently results in death before operati... more Background. Traumatic disruption of the thoracic aorta frequently results in death before operative repair. The determinants of mortality after repair, however, are uncertain. In addition, intraoperative strategies for reducing the incidence of spinal cord injury remain controversial. Methods. The records of 45 consecutive patients under

Research paper thumbnail of Blood flow velocity of internal mammary artery and saphenous vein grafts to the coronary arteries

Journal of Surgical Research, Apr 1, 1988

Doppler-derived blood flow velocity measurements were used to characterize the hemodynamics of 66... more Doppler-derived blood flow velocity measurements were used to characterize the hemodynamics of 66 internal mammary artery grafts and 60 saphenous vein grafts to the coronary arteries at operation. Pulsed Doppler spectral analysis of centerstream graft flow demonstrated predominantly diastolic flow with a variable, multiphasic flow pattern in systole. The magnitude and configuration of the graft flow velocity waveform varied with graft type and whether the runoff was to single or multiple arteries. At operation, peak diastolic flow velocity was greater (P less than 0.0001) in internal mammary artery grafts to a single outflow artery (71 +/- 2 cm/sec) compared with single vein grafts (31 +/- 4 cm/sec). Sequential grafts demonstrated increased flow velocity and forward flow throughout the pulse cycle, indicative of low outflow resistance. Analysis of the phasic flow patterns permitted an assessment of functional graft patency. Technical errors (anastomotic stricture, internal mammary pedicle torsion) were identified in three grafts with low or absent diastolic flow. Vasospasm of the internal mammary artery was associated with high flow velocity throughout the pulse cycle. Observed differences in patency and the development of intimal hyperplasia between internal mammary artery and saphenous vein grafts may be related to graft hemodynamics.

Research paper thumbnail of Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation?

Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2023

Research paper thumbnail of A Unique Hybrid Approach to the Treatment of an Aberrant Right Subclavian Artery Aneurysm

Vascular and Endovascular Surgery, Nov 8, 2012

Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneu... more Aberrant right subclavian artery (ARSA) is an uncommon congenital anomaly that often becomes aneurysmal. The ARSAs are often asymptomatic but aneurysms arising in this location are potentially lethal. Due to the high morbidity and mortality rates associated with the traditional open repair methods, less invasive endovascular methods are becoming more popular. This is a case describing a unique hybrid repair of an aneurysmal ARSA in an asymptomatic male.

Research paper thumbnail of Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: A report from the Randomized On Versus Off Bypass trial

The Journal of Thoracic and Cardiovascular Surgery, 2012

The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) i... more The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) in patients randomized to conventional coronary artery bypass graft (on-pump coronary artery bypass [ONCAB]) versus beating heart coronary surgery (off-pump coronary artery bypass [OPCAB]). Methods: The subgroup of 2103 patients (of 2203 enrollees) in the Randomized On Versus Off Bypass trial with no POAF was studied (1056 patients in the ONCAB group and 1047 patients in the OPCAB group). Univariate and multivariate analyses were used to identify the predictors of POAF and the impact of POAF on outcomes.

Research paper thumbnail of Stroke risk and anticoagulation in the setting of post-cardiac surgery atrial fibrillation: a systematic review of the literature

Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery... more Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery. It remains unclear to what extent POAF increases the stroke risk and whether anticoagulation is warranted in this setting. The primary objective of this review was to conduct a systematic review of the evidence for a correlation between POAF and stroke. Further, we sought to evaluate the published evidence on anticoagulation in the setting of POAF to prevent stroke. To this end, we performed a comprehensive literature search to identify studies on POAF in patients undergoing cardiac surgery with stroke as an outcome. To date, eight meta-analyses providing pooled estimates of the stroke risk associated with POAF in patients undergoing cardiac surgery have been published. The reported pooled odds ratios range from 1.36 to 4.09 for unadjusted estimates. Additionally, five studies were identified that evaluated the impact of anticoagulation on stroke in the setting of POAF. Of these, three supported the use of anticoagulants, and two studies were inconclusive. This systematic review did not find strong supporting evidence that POAF is causally related to stroke, despite a strong correlation with comorbidities and all-cause mortality in the literature. Available evidence to date suggests an elevated risk of bleeding with no clear reduction in stroke or other thromboembolic events when anticoagulation is initiated in the setting of POAF. An upcoming randomized clinical trial by the Cardiothoracic Surgery Network group will hopefully provide clarification on the recommendations for anticoagulation in the setting of POAF after cardiac surgery.

Research paper thumbnail of A Highly Mobile Mass in the Anterior Left Ventricular Outflow Tract Immediately Beneath a Heavily Calcified, Stenotic Aortic Valve: Vegetation, Thrombus, or Neoplasm?

Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2015

Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zd... more Cite this article as: Paul S. Pagel MD, PhD, Derek J. De Vry MD, Balbino E. Lopez MD, Amber K. Zdanovec MD, Brittany N. Price PA-C, Carlos O. Encarnácion MD, Minerva P. Kryniak MD, G. Hossein Almassi MD, A highly mobile mass in the anterior left ventricular outflow tract immediately beneath a heavily calcified, stenotic aortic valve: Vegetation, thrombus, or neoplasm?, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2015.04.028

Research paper thumbnail of Comparative in vitro antimicrobial activity of a novel quinolone, garenoxacin, against aerobic and anaerobic microbial isolates recovered from general, vascular, cardiothoracic and otolaryngologic surgical patients

Journal of Antimicrobial Chemotherapy, Sep 26, 2005

To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusio... more To determine the spectrum of activity of doripenem and to propose tentative MIC and disc diffusion breakpoints. Methods: The in vitro susceptibilities of 2137 bacterial isolates, representing 28 different species, to doripenem, imipenem and meropenem were determined by the NCCLS broth microdilution and disc diffusion testing methods. Results: The doripenem MIC 50 s/ 90 s were (in mg/L) for Enterobacteriaceae, 0.06/0.25; Pseudomonas aeruginosa, 0.25/1; Haemophilus influenzae, 0.12/0.5; streptococci, 0.016/0.5 and for staphylococci, 0.06/4. Like other carbapenems tested, doripenem MIC 50 s/ 90 s were >32/>32 and 0.5/32 mg/L for the enterococci and non-fermentative Gram-negative bacilli (excluding P. aeruginosa), respectively. Against members of the Enterobacteriaceae and H. influenzae, doripenem was generally more active than imipenem and the same as or slightly less active than meropenem. Values for the non-fermentative Gram-negative bacilli excluding P. aeruginosa were comparable for all three carbapenems. Doripenem MICs increased with increasing resistance to methicillin (staphylococci), penicillin (streptococci) and strains that were b-lactamase-negative ampicillin-resistant (Haemophilus). Doripenem exhibits excellent activity against extended-spectrum b-lactamase-producing strains of Escherichia coli and Klebsiella spp. The NCCLS disc diffusion test was performed simultaneously on all organisms. Conclusions: Assuming the MIC susceptible breakpoints for doripenem are < _ 1 mg/L for the streptococci and < _ 2 mg/L for all other genera, then disc diffusion zone diameter breakpoints can be proposed. In addition, MIC and/or disc diffusion quality control ranges of doripenem were determined for 10 ATCC reference strains.

Research paper thumbnail of Mesoatrial shunting for portal decompression in alcoholic cirrhosis

PubMed, Mar 1, 1986

A 36-year-old Chinese man with alcoholic cirrhosis presented to hospital with exsanguinating vari... more A 36-year-old Chinese man with alcoholic cirrhosis presented to hospital with exsanguinating variceal hemorrhage. Conventional porta-systemic decompressive operations could not be done because of dense vascular adhesions from two previous operations and a sub-hepatic abcess. A mesenteric-to-right-atrial shunt was done with successful control of hemorrhage and reduction of portal pressure. Long-term follow-up reveals no further bleeding and a return to full-time employment. We conclude that mesoatrial shunting is a useful alternative procedure for portasystemic decompression in alcoholic cirrhosis, although one which will be needed only in unusual circumstances.

Research paper thumbnail of A case of transdiaphragmatic wound of the heart repaired through the abdomen

Research paper thumbnail of Cardiovascular risk in patients without known cardiovascular disease

PubMed, 2014

Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient... more Understanding the risks of atherosclerotic cardiovascular disease (CVD) allows for better patient education and management. Multiple risk models have been validated in large patient populations and provide insights into the risks associated with CVD. When assessing such risks, we suggest using a model that predicts myocardial infarction, cardiovascular death, and/or cerebrovascular events. In this review, we analyze several risk models and stratify the risks associated with CVD. We suggest that appropriate profiling of patients at-risk of CVD will lead to better physician recognition and treatment of modifiable risk factors, appropriate application of ATP III treatment for hyperlipidemia, and achieving optimal blood pressure control.