Justin Negri - Academia.edu (original) (raw)

Papers by Justin Negri

The Annals of Thoracic Surgery, Apr 1, 2006

Background. An inadequate donor left atrial (LA) cuff due to an anatomical abnormality of the pul... more Background. An inadequate donor left atrial (LA) cuff due to an anatomical abnormality of the pulmonary vasculature or technical errors at the time of procurement can exclude the lungs from transplant. This study aims to describe the incidence, efficacy, and various techniques of LA cuff reconstruction in lung transplantation. Methods. A total of 637 pulmonary venous anastomosis in 405 consecutive lung transplants from January 1995 to July 2005 were reviewed. Comparison between the patients who required LA cuff reconstruction (reconstruction group) or who did not (no-reconstruction group) was made in posttransplant outcomes. Results. An overall incidence of requirement of LA cuff reconstruction was 2.7% (4% on the right, 1% on the left, p ‫؍‬ 0.03). Seventy-one percent of LA inadequacy was corrected using a pericardial patch on the anterior LA cuff wall; the remainder required complicated reconstruction for separated/short pulmonary veins to create a new LA cuff. There was no significant difference between the reconstruction and no-reconstruction groups, respectively, in oxygenation (329 ؎ 28, 337 ؎ 10, p ‫؍‬ 0.81), duration of intubation and intensive care unit stay (p ‫؍‬ 0.54, p ‫؍‬ 0.89, respectively), 30-day mortality (12%, 6%, p ‫؍‬ 0.30), and 5-year survival (57%, 52%, p ‫؍‬ 0.80). Conclusions. Inadequate donor LA cuff is an infrequent but potentially serious complication in lung transplantation. Donor LA cuff reconstruction using donor pericardium or pulmonary artery remnant is a useful technique to salvage surgically marginal lungs without affecting early and late posttransplant outcomes. These lungs should not be excluded from transplantation.

The Annals of Thoracic Surgery, Sep 1, 2015

Journal of Cardiac Surgery, May 19, 2015

Background: Mycotic coronary artery aneurysms are rare and are often fatal without early recognit... more Background: Mycotic coronary artery aneurysms are rare and are often fatal without early recognition and prompt surgical management. Methods: We present a case of mycotic pseudoaneurysm of the left main coronary artery (LMCA) after disseminated methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia. A review of the literature in regards to the surgical management of coronary artery mycotic pseudoaneurysms was conducted. Results: There were 26 reported cases of surgical management of coronary artery mycotic pseudoaneurysms. Coronary artery bypass surgery (CABG) and excision was the most common management (73.1% of cases reviewed). Conclusion: This case highlights the difficultly in diagnosing mycotic coronary artery pseudoaneurysms.

Heart Lung and Circulation, 2007

The Annals of Thoracic Surgery, Feb 1, 2023

Heart Lung and Circulation, Feb 1, 2009

The Asia Pacific Heart Journal, May 1, 1999

Asaio Journal, Feb 28, 2022

Postinfarct ventricular septal defect (PIVSD) is associated with high mortality and the managemen... more Postinfarct ventricular septal defect (PIVSD) is associated with high mortality and the management of these patients has been a challenge with little improvement in outcomes. We commenced a protocol of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for those patients who present in cardiogenic shock with the aim to improve end-organ function before definitive surgical repair to reduce postoperative mortality. This study reviewed the results of this strategy. This was a single-center, retrospective review of all patients who were admitted to our institution with PIVSD in cardiogenic shock from September 2015 to November 2019. Clinical and investigative data were evaluated. Eight patients were referred with PIVSD during this period in cardiogenic shock. One patient had an anterior PIVSD and the other seven had inferior PIVSD. Six patients underwent surgical repair at a median (interquartile range, IQR) of 7 (5-8) days after initiation of VA ECMO. Two patients did not undergo surgical repair. Five patients survived after surgery and one patient died postoperatively due to multiorgan failure. Preoperative use of VA ECMO is a feasible strategy for PIVSD and may improve the results of repair.

Trauma Case Reports, Jun 1, 2020

Blunt traumatic transection of the innominate artery is rare. We describe a case of a 36-year-old... more Blunt traumatic transection of the innominate artery is rare. We describe a case of a 36-year-old male who presented to our Emergency & Trauma Center after being struck by a motor vehicle at high speed. Computerised Tomography (CT) scanning after the patient was stabilised facilitated the prompt diagnosis of the injury. The patient underwent open repair by midline sternotomy, with debranching of the innominate artery, using hypothermic circulatory arrest as a neuroprotective measure. The patient was successfully extubated on post-operative day 3, without neurological deficit. We provide our experience as an option for treating any patient that presents with such an injury.

Heart Lung and Circulation, Jul 1, 2023

Journal of Heart and Lung Transplantation, Feb 1, 2001

Background: Hepatitis C virus (HCV) is reported to be transmitted to the recipients by donor orga... more Background: Hepatitis C virus (HCV) is reported to be transmitted to the recipients by donor organs but the incidence may be lower if cytolytic induction is avoided. We report our mid-term results using HCV positive donors in patients with TDI (cyclosporine, immuran, prednisone) at risk of imminent death (grp I,

Asian Cardiovascular and Thoracic Annals, Apr 1, 2007

In response to the current state of healthcare in Australia, our unit has employed a fast-track p... more In response to the current state of healthcare in Australia, our unit has employed a fast-track policy for low-risk cardiac surgery patients since January 2000. This study was designed to examine the safety and efficacy of this policy. From July 2001 to June 2004, 342 (23%) of 1,488 patients undergoing cardiac surgery were identified preoperatively as suitable for fast-track recovery. There was a significantly shorter median time to extubation (4 hr vs 9 hr), reduced intensive care unit stay (8 hr vs 26 hr), and a lower rate of readmission to the intensive care unit (0.6% vs 4.2%) for those fast tracked compared to the other patients. The fast-track group had a lower incidence of complications and significantly decreased median length of hospital stay (5 vs 7 days). We concluded that this policy accurately identifies the low-risk cardiac surgery patients suitable for less intensive postoperative recovery.

The Journal of Thoracic and Cardiovascular Surgery, Mar 1, 2010

Objective: A pain syndrome related to intercostal nerve injury during internal thoracic artery ha... more Objective: A pain syndrome related to intercostal nerve injury during internal thoracic artery harvesting causes significant morbidity after coronary bypass surgery. We hypothesized that its incidence and severity might be reduced by using skeletonized internal thoracic artery harvesting rather than pedicled harvesting.

The Journal of Heart and Lung Transplantation, 2018

IQR 21-45) vs 24hr (IQR 18-46), p= 0.20] and PGD. There were 2 deaths, one in each group. Conclus... more IQR 21-45) vs 24hr (IQR 18-46), p= 0.20] and PGD. There were 2 deaths, one in each group. Conclusion: A substantial proportion of usable donors will have a PF ratio < 300 measured in the ICU and the OR and function equally well as ≥ 300 donors without an increased risk of PGD or prolonged ventilation. The use of the 300 PF ratio threshold for acceptability of donor lungs results in wastage of donor lungs and unnecessary EVLP.

Innovations (Philadelphia, Pa.)

Leg ischemia is a serious complication of femoral artery cannulation. The primary aim of this stu... more Leg ischemia is a serious complication of femoral artery cannulation. The primary aim of this study was to assess the safety and efficacy of a novel bidirectional femoral arterial cannula (Sorin Group USA, a wholly owned subsidiary of LivaNova PLC, Arvada, CO USA) that provides both antegrade and retrograde flow, in patients undergoing peripheral cannulation for cardiopulmonary bypass during cardiac surgery. Patients undergoing routine cardiac surgery requiring femoral artery cannulation for cardiopulmonary bypass were identified preoperatively. Informed written consent was obtained in all cases. Bidirectional cannula insertion used either a surgical cut-down and wire through needle approach or a percutaneous technique. Flow in the superficial femoral artery was assessed using Doppler ultrasound after commencement of cardiopulmonary bypass. Lower limb perfusion was assessed using reflectance near-infrared spectroscopy to measure regional oxygen saturations in the cannulated limb dur...

The Journal of Heart and Lung Transplantation, 2014

but lungs pre-treated with Ex Vivo Lung Perfusion were not. Kaplan-Meier estimates of the survivo... more but lungs pre-treated with Ex Vivo Lung Perfusion were not. Kaplan-Meier estimates of the survivor function and the log-rank test were performed to investigate the impact of ischemia time (represented by four categorical levels) and other factors upon survival. Ischemia time was defined in three ways; total ischemia time, transport time (cross clamp to out-of-ice) and surgical implant time (out-of-ice to reperfusion of single/second bilateral lung). Results: Over this time, 1,364 adult lung only transplants were performed in the UK. Of these, data were available on total ischemia time for 1,269 patients, on transport time for 1,115 patients and on surgical implant time for 1,110 patients. The median total ischemia time increased from 287 min in 2001 (IQR: 235-330) to 326 min (IQR: 265-409) in 2011 with a peak of 342 min (IQR: 295-448) in 2010. Total ischemia time was split into four categories based on the interquartile range for all times in the cohort; < 4 hours, 4-5 hours, 5-6 hours, > 6 hours. Survival at 30 days for these categories was 93%, 93%, 95% and 92%. The figures at 1 year were 82%, 80%, 82% and 77%. There was no significant difference between these categories in terms of patient survival at 30 days (P= 0.3504) or at 1 year (P= 0.3859). We attempted to identify any effect of transport and implant time. Using an analogous method, there was also found to be no significant difference between the associated four categories for transport time (P= 0.8916 at 30 days and P= 0.6370 at 1 year) or for surgical implant time (P= 0.3096 at 30 days and P= 0.7137 at 1 year). Conclusion: There is increasing confidence in extending ischaemic time, for the lung. Our data supports simplified logistics and national rather than local allocation. If multivariate analysis fails to identify a relationship between ischaemic time and outcome in the presence of other risk factors, or an effect on function, there is further scope for safely extending ischaemic time.

The Journal of Heart and Lung Transplantation, 2019

outcomes included freedom from recurrent or new LVADI and survival at 1 and 2 years following pum... more outcomes included freedom from recurrent or new LVADI and survival at 1 and 2 years following pump exchange. Results: A total of 31 (39% of 80) patients had a LVADI at time of device exchange. Median age was 59 years, 25 (81%) male, 26 (84%) HeartMate 2, and 29 (94%) destination therapy. Indication for exchange was 9 (29%) infection, 10 (32%) hemolysis, and 12 (39%) device failure. Median duration of support prior to infection was 1.1 years (range, 4 days-4.4 years). The most common pathogens were S. aureus (23%), Pseudomonas (19%), and coagulase negative staphylococci (13%). Overall median duration from onset of LVADI to exchange was 270 days (range, 4 days-2.4 years). The median time from onset of LVADI to exchange was shorter in patients with no recurrence of LVADI compared to patients with recurrence (140 vs. 348 days). At one-year post-exchange; ten (32%) patients had recurrence with the same pathogen after a median duration of 25 days, 6 (19%) with a new pathogen after a median duration of 90 days, and 12 (39%) were infection free. The 30-day mortality was 3 (10%) patients. Overall, 16 (51%) patients had recurrent or new LVADI at 1 year and 19 (62%) at 2 years post-exchange. Survival at 1 and 2 years was 52% and 36% and cause of death in most patients was HCVA at 42% and 50%, respectively. Conclusion: For patients receiving a pump exchange with a LVADI, this study suggests a lower incidence of recurrent LVADI with earlier device exchange. While device exchange should remain a consideration for difficult LVADI, it is associated with significant risk of morbidity and mortality at 1 and 2 years. Additional studies are needed to better define management strategies in patients undergoing a device exchange for the control of infection.

Circulation

Background: An internal thoracic artery graft to the left anterior descending artery is standard ... more Background: An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV). Methods: In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or <60 years of age if they had diabetes mellitus) were randomized to receive RA or free RITA graft on the second most important coronary target. In RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients ≥70 years of age (or ≥60 years of age if they had diabetes mellitus) were randomized to receive RA or SV graft. The primary outcome was 10-year graft failure. Long-term mortality was a nonpowered coprimary end point. The main analysis was by intention to treat. Results: In the RA v...

The Journal of Heart and Lung Transplantation