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Papers by Michael Crittenden

Canadian journal of surgery. Journal canadien de chirurgie, 1987

Ascending aortic dissection complicated by aorta-right atrial fistula is a very rare occurrence. ... more Ascending aortic dissection complicated by aorta-right atrial fistula is a very rare occurrence. The patient may present with atypical clinical findings such as a continuous murmur or atrioventricular block, making the diagnosis difficult. Surgical repair is straightforward unless the correct diagnosis is missed, in which case there may be difficulties during the initial period of cardiopulmonary bypass. This report deals with the successful management of a 67-year-old man with this condition.

Background. Acidosis-mediated injury to cardiac myocytes during surgery may lead to progressive h... more Background. Acidosis-mediated injury to cardiac myocytes during surgery may lead to progressive heart failure. The nature of this injury, although not well defined, may be caused by induction of apoptosis in cardiac myocytes. We applied fluorescence imaging and biochemical techniques to assess apoptosis in cardiac myocytes excised from human patients and porcine subjects maintained on cardiopulmonary bypass to demonstrate the relationship between acidosis and apoptosis.

The American Journal of Surgery, Sep 1, 2009

BACKGROUND: This study elucidates the relationship between intraoperative myocardial acidosis/ is... more BACKGROUND: This study elucidates the relationship between intraoperative myocardial acidosis/ ischemia and the risk of unplanned hospital readmissions within 30 days and 6 months after cardiac surgery.

Background. Injury to endothelium can compromise the patency of bypass grafts harvested during co... more Background. Injury to endothelium can compromise the patency of bypass grafts harvested during coronary artery bypass graft (CABG) surgery. Maintaining structural and functional viability of endothelium in grafts may lead to improved long-term patency. The information gained from the application of multi-photon microscopy in transmission and epifluorescence mode was used to assess the structural and functional integrity of human saphenous vein segments stored in multiple preservation solutions, and to design a superior storage solution.

J Amer Coll Cardiol, 1991

The American Journal of Surgery, Oct 1, 2008

BACKGROUND: Myocardial acidosis during cardiac surgery and postoperative troponin I are markers o... more BACKGROUND: Myocardial acidosis during cardiac surgery and postoperative troponin I are markers of myocardial damage that have been shown to predict adverse outcomes. We investigated the relationship between troponin I and myocardial tissue pH, patient outcomes, and cost.

The Journal of Surgical Research, 2001

Background. The use of conventional fluorescence microscopy to image biological systems at the ce... more Background. The use of conventional fluorescence microscopy to image biological systems at the cellular level is limited by its inability to spatially resolve thick tissues. We have applied the technique of multiphoton fluorescence microscopy to study the structure and function of endothelial cells in living human saphenous vein taken from patients undergoing coronary artery bypass surgery.

Annals of Surgery, Aug 1, 1987

Joint Commission journal on quality and patient safety / Joint Commission Resources, 2007

Communication failure, a leading source of adverse events in health care, was involved in approxi... more Communication failure, a leading source of adverse events in health care, was involved in approximately 75% of more than 7,000 root cause analysis reports to the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS). The VA NCPS Medical Team Training (MTT) program, which is based on aviation principles of crew resource management (CRM), is intended to improve outcomes of patient care by enhancing communication between health care professionals. Unique features of MTT include a full-day interactive learning session (facilitated entirely by clinical peers in a health care context), administration of pre-and postintervention safety attitudes questionnaires, and follow-up semistructured interviews with reports of program activities and lessons learned. Examples of projects in these facilities include intensive care unit (ICU) teams' patient-centered multidisciplinary rounds, surgical teams' preoperative briefings and debriefings, an entire operating room ...

American Heart Journal, Mar 1, 1994

Coronary arteriographic results are reported in 1535 black patients: 751 men (mean age 57 +/- 11)... more Coronary arteriographic results are reported in 1535 black patients: 751 men (mean age 57 +/- 11) and 784 women (mean age 59 +/- 11). Among the black men 19%, 15%, 21%, and 4% had single-, double-, and triple-vessel and left main disease, respectively. Among the black women there were 12%, 10%, 15%, and 3% with similar involvement. Logistic regression models showed that most of the recognized risk factors were positively correlated with significant (at least one artery with > or = 50% stenosis) coronary disease, but a history of hypertension was not a significant independent predictor in either sex. ECG evidence of previous infarction increased the odds of detecting significant coronary disease by the greatest amount when controlling for other significant risk markers in women. In men both previous infarction and atypical pain (negative) were equally important. This study confirms but does not explain previous reports that have revealed less than expected angiographic evidence of significant coronary artery disease in black compared with white persons.

Perfusion, 2009

Delirium is an acute change in cognition which occurs frequently after coronary artery bypass gra... more Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery. Non-delirious patients (n=68) were prospectively enrolled and underwent intraoperative monitoring of the middle cerebral arteries with transcranial Doppler (TCD). TCD signals were saved and analyzed postoperatively for microemboli manually, according to established criteria. Postoperatively, patients were assessed for delirium with a standardized battery. Thirty-three patients (48.5%) developed delirium after surgery. Microemboli counts (mean + or - SD) were not significantly different in those with and without delirium (303 + or - 449 vs. 299 + or - 350; p=0.97). While intraoperative microemboli were ...

The Journal of thoracic and cardiovascular surgery, 2007

In patients undergoing cardiac surgery, intraoperative myocardial acidosis, which quantifies regi... more In patients undergoing cardiac surgery, intraoperative myocardial acidosis, which quantifies regional myocardial ischemia, has been shown to increase the risk of adverse postoperative outcomes. In this study, we sought to determine the course of intraoperative myocardial acidosis and its impact on postoperative survival in patients with diabetes mellitus undergoing cardiac surgery. Intraoperative myocardial tissue pH(37C) was continuously measured in the anterior and posterior left ventricular walls in 264 patients undergoing cardiac surgery; 74 (28.0%) of the patients had diabetes (insulin-dependent diabetes: 54%; non-insulin dependent diabetes: 46%). The shortest time required to reach intraoperative myocardial tissue pH < 6.34 during aortic occlusion and > 6.73 during reperfusion were compared in 3 patient groups: insulin-dependent, non-insulin dependent, and nondiabetic. These pH thresholds have been demonstrated to be associated with adverse postoperative long-term surviv...

The American Journal of Surgery, 2009

Journal of Cardiac Failure, 2006