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Papers by Limael Rodriguez

Journal of Pediatric Surgery Case Reports, 2018

Subungual osteochondroma is a rare benign tumor that is often missed at initial evaluation. In th... more Subungual osteochondroma is a rare benign tumor that is often missed at initial evaluation. In this case report, we present a prepubescent boy that presented with a subungual mass, which was misdiagnosed and treated as a simple wart.

International Journal of the Cardiovascular Academy, 2017

Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and a card... more Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and a cardiac chamber or a major vessel. The majority arise from the right coronary artery and drain into the right heart structures. In this report, we present a rare case of a left circumflex coronary artery fistula draining into the coronary sinus managed successfully with surgical intervention.

Annals of Vascular Surgery, 2022

This case report describes 64-year old gentleman who presented with an infected aortic graft, and... more This case report describes 64-year old gentleman who presented with an infected aortic graft, and extracellular material was used as the replacement graft in tubular fashion. The patient did well, but 14 months later developed a pseudoaneurysm ) from the staple line used to construct the ECM conduit. The ECM graft was subsequently explanted ( ) and replaced with Dacron. There was no residual infection. We present histological and mechanical properties of the explanted ECM material ).

This case report describes 64-year old gentleman who presented with an infected aortic graft, and... more This case report describes 64-year old gentleman who presented with an infected aortic graft, and extracellular material was used as the replacement graft in tubular fashion. The patient did well, but 14 months later developed a pseudoaneurysm ) from the staple line used to construct the ECM conduit. The ECM graft was subsequently explanted ( ) and replaced with Dacron. There was no residual infection. We present histological and mechanical properties of the explanted ECM material ).

Purpose: Local recurrence due to inadequate resection is a challenge when treating complex left h... more Purpose: Local recurrence due to inadequate resection is a challenge when treating complex left heart tumors. Previous reports have demonstrated improved survivability with cardiac autotransplantation (ex-vivo resection, reconstruction, and reimplantation). In some cases, concomitant pneumonectomy (PNX) is required when tumor extends to the lungs, which is associated with poorer outcomes. In this study, we present our updated series of patients managed with cardiac autotransplantation (ATx) and report outcomes with and without concomitant PNX. Methods: Since April 1998, a total of 34 consecutive patients with malignant or complex left atrial or ventricular intracavitary cardiac tumors underwent resection via cardiac ATx. Demographics, tumor histology, perioperative data, and outcomes were analyzed. Results: Mean age at the time of surgery was 42 ± 15 years, and males represented 56% (19/34) of the cases. Overall, 74% (25/34) were histologically graded as a sarcoma (or subtype). A pr...

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

During the past 15 years, strategies that promote immediate and complete thrombus removal have ga... more During the past 15 years, strategies that promote immediate and complete thrombus removal have gained popularity for the treatment of acute-onset iliofemoral deep venous thrombosis. In this case report, we describe a novel operative approach to venous thrombus removal known as hybrid operative thrombectomy. The technique employs a direct inguinal approach with concomitant retrograde advancement of a balloon catheter by femoral venotomy. Moreover, it provides effective thrombus removal through a single incision, with or without stent placement, and has the advantage of a completion venogram. (J Vasc Surg: Venous and Lym Dis 2015;-:1-4.)

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2014

Reoperative coronary surgery patients are usually sicker and older, and the procedure is more tec... more Reoperative coronary surgery patients are usually sicker and older, and the procedure is more technically demanding. Comparisons between coronary surgery with (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and without (off-pump CAB [OPCAB]) the pump have been conducted; however, few studies showed results in reoperative cases. We investigate the potential superiority of one technique over the other in redo coronary surgeries. Our institutional Society of Thoracic Surgery database was used to gather the data for 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011. These were divided into the CAB surgery in CPB group (n = 204) and the OPCAB group (n = 62). Baseline characteristics of the two groups were similar, except for a significantly higher prevalence of cerebrovascular disease among the off-pump group (P = 0.01). There was also a trend toward fewer vessels bypassed among the same group (P = 0.07). Risk adjustment was done using multivariable analyses for detection of independent effects. The use of CPB was an independent predictor of increased rates of postoperative events (odds ratio, 3.9; P = 0.004) and atrial fibrillation (odds ratio, 5.9; P < 0.005) and longer intensive care unit (0.006) and hospital stay (0.004). Redo OPCAB seems to offer favorable short-term outcomes compared with redo CAB. Our results suggest a reduced rate of overall postoperative events, decreased new postoperative atrial fibrillation, reduced hours stayed in the intensive care unit, and fewer days stayed from surgery to discharge. This was not associated with an increase in morbidity and mortality. A randomized study with a larger number of patients and with a longer follow-up is needed.

Journal of Cardiothoracic Surgery, 2014

Background: Topical hemostatic agents are used to reduce bleeding and transfusion need during car... more Background: Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. Methods: Data were retrospectively collected for patients (n = 240) that

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

Robotic Surgery: Applications and Advances, 2013

Methodist DeBakey cardiovascular journal

Ventricular assist devices are commonly utilized in the treatment of end-stage heart failure. Adv... more Ventricular assist devices are commonly utilized in the treatment of end-stage heart failure. Advances in continuous flow technology have improved efficiency, size, implantability, extended support, and overall patient outcomes. This has led to an expanded role of left ventricular assist device (LVAD) clinical use and applications. This review describes the advances and current state of LVAD devices and provides a future outlook for this technology.

Boletín de la Asociación Médica de Puerto Rico

Surgical Clinics of North America, 2013

LVAD Noncardiac surgery Left ventricular assist device General surgery Mechanical circulatory sup... more LVAD Noncardiac surgery Left ventricular assist device General surgery Mechanical circulatory support

The Journal of Heart and Lung Transplantation, 2013

DFT) testing the patient's ICD was unsuccessful in multiple configurations and an azygous coil wa... more DFT) testing the patient's ICD was unsuccessful in multiple configurations and an azygous coil was placed. His DFT was at the maximum output of his device (41 J), which was achieved after 7 inductions of VF.

The Journal of Heart and Lung Transplantation, 2013

Conclusions: Aortic valve commissural fusion is a non-inflammatory process, observed in 60% of cf... more Conclusions: Aortic valve commissural fusion is a non-inflammatory process, observed in 60% of cf-LVAD patients. Patients receiving full LVAD support without opening of the valve are most likely to develop commissural fusion. Aortic valve insufficiency is frequently observed in patients with commissural fusion, which might reduce long-term efficiency of cardiac support with cf-LVADs.

Journal of Pediatric Surgery Case Reports, 2018

Subungual osteochondroma is a rare benign tumor that is often missed at initial evaluation. In th... more Subungual osteochondroma is a rare benign tumor that is often missed at initial evaluation. In this case report, we present a prepubescent boy that presented with a subungual mass, which was misdiagnosed and treated as a simple wart.

International Journal of the Cardiovascular Academy, 2017

Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and a card... more Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and a cardiac chamber or a major vessel. The majority arise from the right coronary artery and drain into the right heart structures. In this report, we present a rare case of a left circumflex coronary artery fistula draining into the coronary sinus managed successfully with surgical intervention.

Annals of Vascular Surgery, 2022

This case report describes 64-year old gentleman who presented with an infected aortic graft, and... more This case report describes 64-year old gentleman who presented with an infected aortic graft, and extracellular material was used as the replacement graft in tubular fashion. The patient did well, but 14 months later developed a pseudoaneurysm ) from the staple line used to construct the ECM conduit. The ECM graft was subsequently explanted ( ) and replaced with Dacron. There was no residual infection. We present histological and mechanical properties of the explanted ECM material ).

This case report describes 64-year old gentleman who presented with an infected aortic graft, and... more This case report describes 64-year old gentleman who presented with an infected aortic graft, and extracellular material was used as the replacement graft in tubular fashion. The patient did well, but 14 months later developed a pseudoaneurysm ) from the staple line used to construct the ECM conduit. The ECM graft was subsequently explanted ( ) and replaced with Dacron. There was no residual infection. We present histological and mechanical properties of the explanted ECM material ).

Purpose: Local recurrence due to inadequate resection is a challenge when treating complex left h... more Purpose: Local recurrence due to inadequate resection is a challenge when treating complex left heart tumors. Previous reports have demonstrated improved survivability with cardiac autotransplantation (ex-vivo resection, reconstruction, and reimplantation). In some cases, concomitant pneumonectomy (PNX) is required when tumor extends to the lungs, which is associated with poorer outcomes. In this study, we present our updated series of patients managed with cardiac autotransplantation (ATx) and report outcomes with and without concomitant PNX. Methods: Since April 1998, a total of 34 consecutive patients with malignant or complex left atrial or ventricular intracavitary cardiac tumors underwent resection via cardiac ATx. Demographics, tumor histology, perioperative data, and outcomes were analyzed. Results: Mean age at the time of surgery was 42 ± 15 years, and males represented 56% (19/34) of the cases. Overall, 74% (25/34) were histologically graded as a sarcoma (or subtype). A pr...

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

During the past 15 years, strategies that promote immediate and complete thrombus removal have ga... more During the past 15 years, strategies that promote immediate and complete thrombus removal have gained popularity for the treatment of acute-onset iliofemoral deep venous thrombosis. In this case report, we describe a novel operative approach to venous thrombus removal known as hybrid operative thrombectomy. The technique employs a direct inguinal approach with concomitant retrograde advancement of a balloon catheter by femoral venotomy. Moreover, it provides effective thrombus removal through a single incision, with or without stent placement, and has the advantage of a completion venogram. (J Vasc Surg: Venous and Lym Dis 2015;-:1-4.)

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2014

Reoperative coronary surgery patients are usually sicker and older, and the procedure is more tec... more Reoperative coronary surgery patients are usually sicker and older, and the procedure is more technically demanding. Comparisons between coronary surgery with (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and without (off-pump CAB [OPCAB]) the pump have been conducted; however, few studies showed results in reoperative cases. We investigate the potential superiority of one technique over the other in redo coronary surgeries. Our institutional Society of Thoracic Surgery database was used to gather the data for 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011. These were divided into the CAB surgery in CPB group (n = 204) and the OPCAB group (n = 62). Baseline characteristics of the two groups were similar, except for a significantly higher prevalence of cerebrovascular disease among the off-pump group (P = 0.01). There was also a trend toward fewer vessels bypassed among the same group (P = 0.07). Risk adjustment was done using multivariable analyses for detection of independent effects. The use of CPB was an independent predictor of increased rates of postoperative events (odds ratio, 3.9; P = 0.004) and atrial fibrillation (odds ratio, 5.9; P < 0.005) and longer intensive care unit (0.006) and hospital stay (0.004). Redo OPCAB seems to offer favorable short-term outcomes compared with redo CAB. Our results suggest a reduced rate of overall postoperative events, decreased new postoperative atrial fibrillation, reduced hours stayed in the intensive care unit, and fewer days stayed from surgery to discharge. This was not associated with an increase in morbidity and mortality. A randomized study with a larger number of patients and with a longer follow-up is needed.

Journal of Cardiothoracic Surgery, 2014

Background: Topical hemostatic agents are used to reduce bleeding and transfusion need during car... more Background: Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. Methods: Data were retrospectively collected for patients (n = 240) that

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

Robotic Surgery: Applications and Advances, 2013

Methodist DeBakey cardiovascular journal

Ventricular assist devices are commonly utilized in the treatment of end-stage heart failure. Adv... more Ventricular assist devices are commonly utilized in the treatment of end-stage heart failure. Advances in continuous flow technology have improved efficiency, size, implantability, extended support, and overall patient outcomes. This has led to an expanded role of left ventricular assist device (LVAD) clinical use and applications. This review describes the advances and current state of LVAD devices and provides a future outlook for this technology.

Boletín de la Asociación Médica de Puerto Rico

Surgical Clinics of North America, 2013

LVAD Noncardiac surgery Left ventricular assist device General surgery Mechanical circulatory sup... more LVAD Noncardiac surgery Left ventricular assist device General surgery Mechanical circulatory support

The Journal of Heart and Lung Transplantation, 2013

DFT) testing the patient's ICD was unsuccessful in multiple configurations and an azygous coil wa... more DFT) testing the patient's ICD was unsuccessful in multiple configurations and an azygous coil was placed. His DFT was at the maximum output of his device (41 J), which was achieved after 7 inductions of VF.

The Journal of Heart and Lung Transplantation, 2013

Conclusions: Aortic valve commissural fusion is a non-inflammatory process, observed in 60% of cf... more Conclusions: Aortic valve commissural fusion is a non-inflammatory process, observed in 60% of cf-LVAD patients. Patients receiving full LVAD support without opening of the valve are most likely to develop commissural fusion. Aortic valve insufficiency is frequently observed in patients with commissural fusion, which might reduce long-term efficiency of cardiac support with cf-LVADs.