Satoru Osaki - Academia.edu (original) (raw)

Papers by Satoru Osaki

Research paper thumbnail of Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation

Interactive cardiovascular and thoracic surgery, 2012

This study was undertaken to evaluate outcomes for single (SLT) vs. bilateral lung transplantatio... more This study was undertaken to evaluate outcomes for single (SLT) vs. bilateral lung transplantation (BLT) in patients with interstitial lung disease (ILD). One hundred and eleven patients with ILD who underwent lung transplantation between January 1993 and March 2009 were evaluated. Recipients with BLT were younger (43 ± 12 vs. 57 ± 7 years), and significantly more patients with non-idiopathic pulmonary fibrosis (IPF) received BLT (50%) vs. patients with IPF (18%). BLT recipients had a significantly longer mean waitlist time (240 vs. 125 days), significantly higher systolic (51 ± 18 vs. 40 ± 11 mmHg) pulmonary artery pressures, were placed on cardiopulmonary bypass more frequently (67 vs. 31%), had a higher incidence of primary graft dysfunction (63 vs. 17%), more frequently were given prolonged peri-operative inhaled nitric oxide and more frequently required prolonged post-operative mechanical ventilatory support (6.0 vs. 1.7 days). Additionally, BLT recipients had a significantly l...

Research paper thumbnail of 413: Impact of the UNOS Lung Allocation Score on Lung Transplantation for Chronic Obstructive Pulmonary Disease

The Journal of Heart and Lung Transplantation, 2010

51.5% of the recipient measured total lung capacity. LGVR was carried out using linear cutting st... more 51.5% of the recipient measured total lung capacity. LGVR was carried out using linear cutting staplers in the form of bilateral apical segmentectomy in 2 cases, lingulectomy in 5 cases and multiple wedge resections of all lobes in 6 cases. 4 patients underwent formal pulmonary lobectomy. 4 patients were extubated within 24 hours and 6 patients were extubated between 1-16 days (mean -4.33 days). One died whilst on the ventilator (24 days). The mean ITU stay was 13 days (range 2-56 days). 4 (33.33%) patients died at a mean duration of 1.75 months (range 1-5 months). 8 patients (66.67%) remain alive at a mean duration of 38 months (range 10-74 months).

Research paper thumbnail of 409: Minimizing Post Operative Ventilation Times in Lung Transplant Recipients

The Journal of Heart and Lung Transplantation, 2010

on patients undergoing H/L Tx for CTEPH and IPAH were analysed retrospectively. The recipient dem... more on patients undergoing H/L Tx for CTEPH and IPAH were analysed retrospectively. The recipient demographics, co-morbidities, donor data, CMV mismatch, operative details, duration ventilation, and ICU stay, post-operative complications, freedom from bronchiolitis obliterans syndrome (BOS) and long term survival were compared between the groups. Results: A total of 56/330 (17%) patients underwent H/L Tx for pulmonary vascular disease. Nine out of 56 (16%) suffered CTEPH and the remaining were IPAH 47/56 (84%). The median duration of follow up for the entire cohort was 1104(25,75 centiles 90, 2844)days. The baseline demographic factors were comparable between the groups except significant female predominance in IPAH group (pϭ0.02). Post-operative episodes of acute rejection (pϭ0.09), CMV mismatch (pϭ0.72), fungal infection(pϭ0.99) and freedom from BOS at 1 year(85% vs. 67%;pϭ0.78) were similar between the groups. The one year (79% vs. 67%) and 5 year (51% vs. 55%) survival for IPAH and CTEPH respectively, were also similar.[figure1]

Research paper thumbnail of 335: Impact of the UNOS Lung Allocation Scoring System on Lung Transplantation for Interstitial Lung Disease

The Journal of Heart and Lung Transplantation, 2010

Research paper thumbnail of Lung transplant for interstitial lung disease: outcomes before and after implementation of the united network for organ sharing lung allocation scoring system

European Journal of Cardio-Thoracic Surgery, 2012

OBJECTIVES: This study was undertaken to evaluate whether the adoption of the united network for ... more OBJECTIVES: This study was undertaken to evaluate whether the adoption of the united network for organ sharing lung allocation score (LAS) was associated with significant changes in lung transplantation (LTX) outcomes for patients with interstitial lung disease (ILD) who underwent LTX at the University of Wisconsin Hospital and Clinics.

Research paper thumbnail of Redo lung transplantation for acute and chronic lung allograft failure: long-term follow-up in a single center

European Journal of Cardio-Thoracic Surgery, 2008

Objective: This study was undertaken to evaluate outcomes of redo lung transplantation (LT) for a... more Objective: This study was undertaken to evaluate outcomes of redo lung transplantation (LT) for acute and chronic graft failure. Methods: Between 1988 and 2007, 388 LT procedures were performed on 369 patients. From those, 17 (4.6%) patients had redo LT once and 2 patients had redo LT twice. Patient survival and recurrence of bronchiolitis obliterans syndrome (BOS) after redo LT were reviewed. Results: The overall survival rates of the 17 redo LT recipients at 1, 2 and 5 years were 59 AE 23%, 59 AE 23% and 42 AE 25%, respectively. For the chronic graft failure group (n = 12), survival rates at 1, 2 and 5 years were 67 AE 26%, 67 AE 26% and 44 AE 30%, respectively. These survival rates were significantly lower than the survival rates observed in our experience after primary LT (n = 352, 1-, 2-and 5-year survival rates of 88 AE 4%, 80 AE 4% and 65 AE 5%, respectively. For the acute graft failure group (n = 5), the 1-year survival rate was 40%; two patients remain free from BOS. Two patients had a second redo LT, one died from multi-organ failure on postoperative day 86 and the other died from pulmonary aspergillosis on postoperative day 214. Conclusions: Redo LT is a valid therapeutic option for selected patients with BOS and might be an option for highly selected patients with acute lung graft failure. Outcomes from a second redo LT are poor, and a second lung retransplantation must be used very cautiously, if at all. Published by Elsevier B.V. on behalf of European Association for Cardio-Thoracic Surgery.

Research paper thumbnail of The impact of the lung allocation scoring system at the single national Veterans Affairs Hospital lung transplantation program☆

European Journal of Cardio-Thoracic Surgery, 2009

The lung allocation score (LAS) has changed the distribution of donor lungs for transplantation. ... more The lung allocation score (LAS) has changed the distribution of donor lungs for transplantation. This study was undertaken to evaluate the impact of the LAS on a unique patient population undergoing lung transplantation (LTX) at the single national Veterans Affairs (VA) LT center. One hundred and ten consecutive VA patients underwent LTX between 1994 and 2007. Patients transplanted using the LAS (LAS, n=26) were compared to patients transplanted prior to introduction of the LAS (pre-LAS, n=84). Waiting time decreased from 353.8+/-254.7 (pre-LAS) to 238.0+/-306.6 (LAS) days (p<0.01). Recipient diagnoses have changed with an increase in idiopathic pulmonary fibrosis [11% (9/84) pre-LAS vs 46% (12/26) LAS, p<0.01] and a decrease in emphysema [57% (48/84) pre-LAS vs 35% (9/26) LAS, p<0.01]. Mean LAS calculation was 33.1+/-2.9 for pre-LAS versus 41.9+/-9.8 for the LAS (p<0.01). Postoperative complications did not differ between the groups. Length of hospital stay decreased from 44.3+/-42.9 (pre-LAS) to 18.1+/-12.3 (LAS) days (p<0.01). Hospital mortality and 1-year survival did not differ between the pre-LAS and LAS groups (7% vs 8%; p=0.72 and 92% [95% confidence interval (CI) 86-98] vs 92% [CI 82-100]; p=0.23, respectively). The LAS appears to be achieving its objectives by reducing waitlist time and altering the distribution of lung disease being transplanted on the basis of medical necessity in the U.S. VA population. In addition, the LAS does not appear to have adversely affected short-term post-transplant outcomes in our recipient cohort.

Research paper thumbnail of Off-pump transapical mitral valve replacement☆

European Journal of Cardio-Thoracic Surgery, 2009

Objective: Percutaneous valve replacement was recently introduced, and reports of early clinical ... more Objective: Percutaneous valve replacement was recently introduced, and reports of early clinical experience have already been published. To date, this technique is limited to the replacement of pulmonary and aortic valves in a strictly selected group of patients. The aim of this study was to analyse a self-expanding valved stent for minimally invasive replacement of the mitral valve in animals. Methods: A newly designed nitinol stent was specially designed for this experimental acute study. It comprised of a left ventricular tubular stent with star shaped left atrial anchoring springs and carried a trileaflet bovine pericardial valve. A polytetrafluoroethylene membrane was sutured to envelop the atrial springs and the outside of the ventricular stent. The ventricular anchoring system was the same as in our previously reported results with a similar mitral valved stent. Seven pigs underwent minimally invasive off-pump mitral valved stent implantation. This was performed through a lower ministernotomy and a standard transapical approach under transoesophageal echocardiographic (TEE) guidance was used. Results: The valved stent is fully retrievable and precise deployment and accurate adjustment of its intra-annular position is achievable to eliminate paravalvular leakage. The deployment time ranged from 127 to 255 s and the blood loss from 70 to 220 cc. One animal died of intractable ventricular fibrillation. Mitral regurgitation in all surviving animals was minimal (trace in 5/6 and mild in 1/6 during echo examination; on the contrast ventriculogram no mitral insufficiency was observed except in one documented as mild paravalvular regurgitation). These animals remained haemodynamically stable (6/ 6) and without TEE or ventriculographic changes for 1 h. Conclusion: Implantation of a tricuspid bovine pericardial valved stent in the mitral position is feasible in pigs through a transcatheter approach. This was possible through a smaller delivery system than previously reported. Additional studies are required to demonstrate long-term feasibility, durability, and heart function. #

Research paper thumbnail of 408: Ventricular Assist Device Patients Managed Safely at Home 100 Miles or More from Implant Center

J Heart Lung Transplant, 2008

Purpose: Primary graft dysfunction (PGD) is a major obstacle limiting success of clinical lung tr... more Purpose: Primary graft dysfunction (PGD) is a major obstacle limiting success of clinical lung transplantation (LTX). PGD involves an influx of polymorphonuclear neutrophils to the graft with exacerbation of inflammation. Reparixin is a specific, non-competitive, allosteric, blocker of the two receptors (CXCR1 and 2) of CXCL8, a chemokine involved in leukocyte recruitment to the lung. This study evaluates safety and efficacy of Reparixin in clinical LTX. Methods and Materials: 223 patients were screened, 114 were randomized. Thirteen randomized patients were annulled; 7 because the LTX was canceled, 2 because the study drug was not delivered, and 4 for other reasons. Thus, 101 patients were entered. Primary endpoints evaluated were PaO2/FiO2 ratios immediately and 24 hours after LTX. Results: Of 101 patients entered, 46 received Reparixin and 55 received placebo. Groups were comparable in recipient age, gender, race, CMV status and lung allocation score. Donor age, gender and cause of death were equivalent in the groups. The primary efficacy endpoint (PaO2/FiO2 ratio) did not significantly differ between groups immediately or at 24 hours post-op. The values were (332Ϯ19) for the Reparixin group and (319Ϯ19) for the controls at time zero; and (305Ϯ24) for the Reparixin group and (290Ϯ20) for the controls at 24 hours. Adverse events did not differ between groups. All 46 Reparixin patients survived to month 1, while 3 patients in the placebo group failed to reach the 1 month endpoint. Two of these patients were re-transplanted and one died. Mortality in the first 12 months after transplant was 6/55 (11%) in the placebo group and 0/46 (0%) in the Reparixin group.(pϭ.03). Conclusions: In this study, treatment with Reparixin did not significantly impact PaO2/FiO2 ratios immediately or 24 hours after LTX. There were no apparent safety issues with the drug at the doses provided. The short and long term benefits in patient and graft survival are intriguing and merit additional study in this clinical setting.

Research paper thumbnail of Surgery Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Discrepancy Between Intraoperative Transesophageal Echocardiography and

Research paper thumbnail of Evaluation of the Appropriate Root Pressure for Maintaining Heartbeat during an Aortic Cross-clamp for Primary Repair of the Aortic Arch in Premature Infants with Associated Cardiac Anomalies

Acta Medica Okayama, Dec 1, 2010

We developed a new cardiopulmonary bypass (CPB) method to minimize myocardial damage during aorti... more We developed a new cardiopulmonary bypass (CPB) method to minimize myocardial damage during aortic arch reconstruction. In this method, coronary flow and heartbeat were stabilized by maintaining the aortic root pressure with an adjusted preload of the ventricle during aortic cross-clamping. This study was performed to determine the appropriate root pressure to maintain the heartbeat without causing deterioration of ventricular function. Study 1. Under partial CPB, the ascending aorta was cross-clamped in 6 pigs (group 1). Experimental data at various systolic aortic root pressures was analysed to determine the appropriate root pressure. Study 2. In group 2 (control, n＝6), the aorta was not clamped, while in group 3 (n＝6), the aorta was cross-clamped for 60 min and the systolic aortic root pressure was maintained at the pressure determined in study 1. Study 1. The diastolic coronary flow was stabilized at values comparable to that before initiation of CPB (6.6±1.4 ml/beat) when the systolic aortic root pressure was above 80 mmHg. Intracardiac pressure and the myocardial oxygen consumption (MvO2) seemed to be acceptable when the systolic aortic root pressure was below 100 mmHg. Therefore, 90 mmHg was selected for study 2. Study 2. Perioperative cardiac function did not differ between the groups. We concluded that 90 mmHg was the systolic aortic root pressure appropriate for this method.

Research paper thumbnail of Negative results - Thoracic general Unusual late presentation of asymptomatic diaphragmatic hernia following ventricular assist device explantation

The role of left ventricular assist device (LVAD ) in treatment options of congestive heart failu... more The role of left ventricular assist device (LVAD ) in treatment options of congestive heart failure is becoming more important and the widespread application is imminent. There are, however, some serious complications associated with LVAD, which make patient management more challenging. We report a rare surgical case of asymptomatic diaphragmatic hernia, which was diagnosed 8.5 years after heart transplantation and

Research paper thumbnail of To Explant or Not to Explant: An Invasive and Noninvasive Monitoring Protocol to Determine the Need of Continued Ventricular Assist Device Support

Congestive Heart Failure, Mar 1, 2009

Research paper thumbnail of Diagnosis-Based Differences in Response of Global Ventricular Performance to Modified Ultrafiltration in Children

Circ J, 2010

To determine diagnosis-based differences in the response of global ventricular performance to mod... more To determine diagnosis-based differences in the response of global ventricular performance to modified ultrafiltration (MUF) using transesophageal echocardiography during congenital heart surgery. The study included 38 children with atrial septal defect (n=10), ventricular septal defect (VSD) (n=8), tetralogy of Fallot (TOF) (n=9), or a single ventricle (n=11). Arteriovenous MUF was performed for 10-15 min after cardiopulmonary bypass (CPB). The myocardial performance index (MPI) of the systemic ventricles and the % change in MPI before and after MUF were assessed. Impairment of MPI was noted at termination of CPB compared with baseline values in the VSD and TOF groups (P<0.05). MUF resulted in an improvement in MPI in all groups (P<0.01). There was a weak correlation between aortic cross-clamping or CPB time, and the degree of improvement in MPI (r= 0.385, P=0.019; r= 0.348, P=0.037, respectively). MUF improved fractional shortening in all groups (P<0.05) and reversed abnormal relaxation in the VSD and TOF groups. Modified ultrafiltration ameliorated MPI in all groups, indicating improved systemic ventricular function with MUF. The MPI recovery rate differed among the groups. MUF may be particularly useful for restoring the global ventricular performance of patients undergoing longer CPB and may have minimal advantages for simple open-heart surgery. (Circ J 2010; 74: 86 - 92).

Research paper thumbnail of 566: Improved Outcomes after Ventricular Assist Device Implantation in Patients Requiring Intra-Aortic Balloon Pump

J Heart Lung Transplant, 2010

Research paper thumbnail of Free radical scavenger MCI-186 ameliorates reperfusion injury in hearts harvested from non-heart-beating-donors

J Heart Lung Transplant, 2005

To project how use of NHBD hearts could increase heart donation, we retrospectively reviewed dono... more To project how use of NHBD hearts could increase heart donation, we retrospectively reviewed donor databases from Gift of Life Donor Program (GLDP), our local procurement organization, from 2001-2003. We screened the NHBD population using conservative donor criteria, assuming an acceptable hypoxic/ischemic time (time from withdrawal of care to cross clamp) of 30 min. Results: During the study period there were 894 HBDs, 334 heart transplants, and 119 NHBDs. During this time the number of HBDs increased by 5%, and the NHBD pool increased by 22%. NHBDs were similar to HBDs with respect to gender and ethnicity, but NHBDs were proportionately younger. Of 119 NHBDs, 55 did not meet the age criteria (Յ45 yrs), and 20 were eliminated for incomplete data. 20 NHBDs met all cardiac donor criteria. 82 NHBDs were cross-clamped within 30 min of care withdrawal. 14 of 20 NHBDs met cardiac donor criteria and had hypoxic/ischemic times Յ30 min. Pro rata estimation for the 20 NHBDs with incomplete data suggested 7 potential additional donors. Conclusion: The annual number of NHBDs increased while that of HBDs remained essentially fixed. NHBDs were demographically similar to HBDs in terms of gender and race but included a relatively greater proportion of younger individuals. If NHBD hearts identified by our criteria could have been transplanted, they would have provided GLDP with 14 to 21 additional hearts in a time interval in which 334 heart transplants were performed.

Research paper thumbnail of A novel approach to prevent post-operative ileus after continuous-flow left ventricular assist device implantation: A retrospective cohort study

International Journal of Surgery, 2015

Patients with postoperative ileus (POI), a common post-surgical event, experience intense discomf... more Patients with postoperative ileus (POI), a common post-surgical event, experience intense discomfort. Various treatments targeting prevention of POI have shown to have an unpredictable effect. We introduced a novel postoperative bowel management protocol in patients implanted with a continuous-flow left ventricular assist device (CF-LVAD). The effect of this protocol on POI was evaluated. Patients receiving an old bowel management protocol (OBMP; 01/2007-03/2009) were compared with those receiving a new bowel management protocol (NBMP; 04/2009-12/2013). The OBMP consisted of advancing the diet as tolerated, bisacodyl suppositories and enemas with the goal of a bowel movement (BM) every 3 days. The NBMP consisted of clear liquids until first BM is achieved, then full liquids until the second BM, then advancing to goal diet. Docusate is given on postoperative day (POD) 1 and bisacodyl PR on POD2 with enemas if ileus develops. Enemas are added POD3 if no BM has occurred. Polyethylene glycol is considered daily for patients prone to constipation. The goal is a BM every 2 days. Patients were made nil per os (NPO) with any signs of ileus. One hundred eighteen patients were implanted with CF-LVADs during the study period. The incidence of ileus significantly decreased from 19% in the OBMP group to 4% percent in the NBMP group (p < 0.05). In-hospital mortality was not different between the two groups (6% vs. 2% p = 0.35). A novel postoperative bowel management protocol successfully decreased the incidence of POI following CF-LVAD implant surgery at our institution.

Research paper thumbnail of Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis

The Annals of Thoracic Surgery, 2015

We investigated the incidence and causes of unplanned hospital readmissions after continuous-flow... more We investigated the incidence and causes of unplanned hospital readmissions after continuous-flow (CF) left ventricular assist device (LVAD) implantation. We also analyzed the impact of unplanned readmissions on post-CF-LVAD survival and the costs associated with each cause of readmission. We retrospectively reviewed 126 patients who underwent implantation with a CF-LVAD from January 2007 to December 2013. The timing of readmissions, hospital length of stay, and total length of device support were evaluated. Patients were followed up while receiving support, until transplantation, or until death. Direct hospital costs associated with each readmission were analyzed. In all, 103 patients underwent implantation for bridge to transplantation and 19 patients for destination therapy; 68 patients were readmitted 156 times (2.2 times/patient) as of the end of follow-up. The median follow-up period was 11 months. While receiving device support, patients spent 93% of their time out of the hospital. The causes of readmission included gastrointestinal bleeding (19%), driveline infection (13%), and stroke (8%). The median time to first readmission was 35 days. Thirty (44%) patients were readmitted within 30 days after discharge. The median direct hospital cost of a single readmission was $7,546. Device malfunction and arrhythmias were the most costly causes of readmission. There was no significant difference in long-term survival between readmitted patients and those who were not readmitted. Gastrointestinal bleeding and CF-LVAD-related infections were the leading causes of readmission. Patients with a CF-LVAD spent 93% of their time out of hospital after implantation, and readmissions did not have a negative impact on long-term survival. New approaches to minimize these adverse events will continue to improve the efficacy and decrease the cost of CF-LVAD therapy.

Research paper thumbnail of Impact of age on outcomes following continuous-flow left ventricular assist device implantation

Interactive cardiovascular and thoracic surgery, Jan 13, 2015

The goal of our study was to analyse the impact of age on outcomes in patients who underwent cont... more The goal of our study was to analyse the impact of age on outcomes in patients who underwent continuous-flow left ventricular assist device (CF-LVAD) placement at our institution. One hundred and twenty-eight patients were implanted with a CF-LVAD between January 2008 and June 2014. Eighty-five patients were implanted with the device as a bridge to transplant (BTT); the remaining (n = 43) were on destination therapy (DT). Each group was divided into patients <65 years old and ≥65 years old at device implantation. Patients were followed up for at least 24 months or until transplant or death. Eighty-five patients (66%) received a CF-LVAD as BTT. Patients ≥65 years old (n = 8) had a lower preoperative cardiac index and prothrombin time-international normalized ratio (P = 0.009), and a longer stay in the intensive care unit (P = 0.008). Adverse events including infections, re-exploration for bleeding, ischaemic and haemorrhagic stroke, renal failure and right heart failure were compa...

Research paper thumbnail of Traumatic pericardial rupture without cardiac injury

General thoracic and cardiovascular surgery, 2008

Pericardial rupture is a rare injury following blunt chest trauma. It is frequently fatal because... more Pericardial rupture is a rare injury following blunt chest trauma. It is frequently fatal because of serious complications such as cardiac herniation and/or contusion. We report a case of traumatic pericardial rupture without cardiac injury, which was incidentally identified intraoperatively. A 63-year-old woman was transported to the hospital after sustaining blunt chest trauma from a motor vehicle accident. Radiographic workup demonstrated multiple fractures, pulmonary contusion, and hemopneumothorax. A chest tube was inserted, and persistent bleeding was observed. An exploratory thoracotomy was performed, and active pulmonary bleeding was controlled. Further exploration revealed major pericardial rupture without cardiac herniation or intrapericardial injury, which was repaired by a bovine pericardial patch. Her postoperative course was uneventful. It is usually difficult to make a diagnosis of pericardial rupture, and a misdiagnosis often leads to a fatal consequence. Therefore, ...

Research paper thumbnail of Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation

Interactive cardiovascular and thoracic surgery, 2012

This study was undertaken to evaluate outcomes for single (SLT) vs. bilateral lung transplantatio... more This study was undertaken to evaluate outcomes for single (SLT) vs. bilateral lung transplantation (BLT) in patients with interstitial lung disease (ILD). One hundred and eleven patients with ILD who underwent lung transplantation between January 1993 and March 2009 were evaluated. Recipients with BLT were younger (43 ± 12 vs. 57 ± 7 years), and significantly more patients with non-idiopathic pulmonary fibrosis (IPF) received BLT (50%) vs. patients with IPF (18%). BLT recipients had a significantly longer mean waitlist time (240 vs. 125 days), significantly higher systolic (51 ± 18 vs. 40 ± 11 mmHg) pulmonary artery pressures, were placed on cardiopulmonary bypass more frequently (67 vs. 31%), had a higher incidence of primary graft dysfunction (63 vs. 17%), more frequently were given prolonged peri-operative inhaled nitric oxide and more frequently required prolonged post-operative mechanical ventilatory support (6.0 vs. 1.7 days). Additionally, BLT recipients had a significantly l...

Research paper thumbnail of 413: Impact of the UNOS Lung Allocation Score on Lung Transplantation for Chronic Obstructive Pulmonary Disease

The Journal of Heart and Lung Transplantation, 2010

51.5% of the recipient measured total lung capacity. LGVR was carried out using linear cutting st... more 51.5% of the recipient measured total lung capacity. LGVR was carried out using linear cutting staplers in the form of bilateral apical segmentectomy in 2 cases, lingulectomy in 5 cases and multiple wedge resections of all lobes in 6 cases. 4 patients underwent formal pulmonary lobectomy. 4 patients were extubated within 24 hours and 6 patients were extubated between 1-16 days (mean -4.33 days). One died whilst on the ventilator (24 days). The mean ITU stay was 13 days (range 2-56 days). 4 (33.33%) patients died at a mean duration of 1.75 months (range 1-5 months). 8 patients (66.67%) remain alive at a mean duration of 38 months (range 10-74 months).

Research paper thumbnail of 409: Minimizing Post Operative Ventilation Times in Lung Transplant Recipients

The Journal of Heart and Lung Transplantation, 2010

on patients undergoing H/L Tx for CTEPH and IPAH were analysed retrospectively. The recipient dem... more on patients undergoing H/L Tx for CTEPH and IPAH were analysed retrospectively. The recipient demographics, co-morbidities, donor data, CMV mismatch, operative details, duration ventilation, and ICU stay, post-operative complications, freedom from bronchiolitis obliterans syndrome (BOS) and long term survival were compared between the groups. Results: A total of 56/330 (17%) patients underwent H/L Tx for pulmonary vascular disease. Nine out of 56 (16%) suffered CTEPH and the remaining were IPAH 47/56 (84%). The median duration of follow up for the entire cohort was 1104(25,75 centiles 90, 2844)days. The baseline demographic factors were comparable between the groups except significant female predominance in IPAH group (pϭ0.02). Post-operative episodes of acute rejection (pϭ0.09), CMV mismatch (pϭ0.72), fungal infection(pϭ0.99) and freedom from BOS at 1 year(85% vs. 67%;pϭ0.78) were similar between the groups. The one year (79% vs. 67%) and 5 year (51% vs. 55%) survival for IPAH and CTEPH respectively, were also similar.[figure1]

Research paper thumbnail of 335: Impact of the UNOS Lung Allocation Scoring System on Lung Transplantation for Interstitial Lung Disease

The Journal of Heart and Lung Transplantation, 2010

Research paper thumbnail of Lung transplant for interstitial lung disease: outcomes before and after implementation of the united network for organ sharing lung allocation scoring system

European Journal of Cardio-Thoracic Surgery, 2012

OBJECTIVES: This study was undertaken to evaluate whether the adoption of the united network for ... more OBJECTIVES: This study was undertaken to evaluate whether the adoption of the united network for organ sharing lung allocation score (LAS) was associated with significant changes in lung transplantation (LTX) outcomes for patients with interstitial lung disease (ILD) who underwent LTX at the University of Wisconsin Hospital and Clinics.

Research paper thumbnail of Redo lung transplantation for acute and chronic lung allograft failure: long-term follow-up in a single center

European Journal of Cardio-Thoracic Surgery, 2008

Objective: This study was undertaken to evaluate outcomes of redo lung transplantation (LT) for a... more Objective: This study was undertaken to evaluate outcomes of redo lung transplantation (LT) for acute and chronic graft failure. Methods: Between 1988 and 2007, 388 LT procedures were performed on 369 patients. From those, 17 (4.6%) patients had redo LT once and 2 patients had redo LT twice. Patient survival and recurrence of bronchiolitis obliterans syndrome (BOS) after redo LT were reviewed. Results: The overall survival rates of the 17 redo LT recipients at 1, 2 and 5 years were 59 AE 23%, 59 AE 23% and 42 AE 25%, respectively. For the chronic graft failure group (n = 12), survival rates at 1, 2 and 5 years were 67 AE 26%, 67 AE 26% and 44 AE 30%, respectively. These survival rates were significantly lower than the survival rates observed in our experience after primary LT (n = 352, 1-, 2-and 5-year survival rates of 88 AE 4%, 80 AE 4% and 65 AE 5%, respectively. For the acute graft failure group (n = 5), the 1-year survival rate was 40%; two patients remain free from BOS. Two patients had a second redo LT, one died from multi-organ failure on postoperative day 86 and the other died from pulmonary aspergillosis on postoperative day 214. Conclusions: Redo LT is a valid therapeutic option for selected patients with BOS and might be an option for highly selected patients with acute lung graft failure. Outcomes from a second redo LT are poor, and a second lung retransplantation must be used very cautiously, if at all. Published by Elsevier B.V. on behalf of European Association for Cardio-Thoracic Surgery.

Research paper thumbnail of The impact of the lung allocation scoring system at the single national Veterans Affairs Hospital lung transplantation program☆

European Journal of Cardio-Thoracic Surgery, 2009

The lung allocation score (LAS) has changed the distribution of donor lungs for transplantation. ... more The lung allocation score (LAS) has changed the distribution of donor lungs for transplantation. This study was undertaken to evaluate the impact of the LAS on a unique patient population undergoing lung transplantation (LTX) at the single national Veterans Affairs (VA) LT center. One hundred and ten consecutive VA patients underwent LTX between 1994 and 2007. Patients transplanted using the LAS (LAS, n=26) were compared to patients transplanted prior to introduction of the LAS (pre-LAS, n=84). Waiting time decreased from 353.8+/-254.7 (pre-LAS) to 238.0+/-306.6 (LAS) days (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Recipient diagnoses have changed with an increase in idiopathic pulmonary fibrosis [11% (9/84) pre-LAS vs 46% (12/26) LAS, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01] and a decrease in emphysema [57% (48/84) pre-LAS vs 35% (9/26) LAS, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01]. Mean LAS calculation was 33.1+/-2.9 for pre-LAS versus 41.9+/-9.8 for the LAS (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Postoperative complications did not differ between the groups. Length of hospital stay decreased from 44.3+/-42.9 (pre-LAS) to 18.1+/-12.3 (LAS) days (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Hospital mortality and 1-year survival did not differ between the pre-LAS and LAS groups (7% vs 8%; p=0.72 and 92% [95% confidence interval (CI) 86-98] vs 92% [CI 82-100]; p=0.23, respectively). The LAS appears to be achieving its objectives by reducing waitlist time and altering the distribution of lung disease being transplanted on the basis of medical necessity in the U.S. VA population. In addition, the LAS does not appear to have adversely affected short-term post-transplant outcomes in our recipient cohort.

Research paper thumbnail of Off-pump transapical mitral valve replacement☆

European Journal of Cardio-Thoracic Surgery, 2009

Objective: Percutaneous valve replacement was recently introduced, and reports of early clinical ... more Objective: Percutaneous valve replacement was recently introduced, and reports of early clinical experience have already been published. To date, this technique is limited to the replacement of pulmonary and aortic valves in a strictly selected group of patients. The aim of this study was to analyse a self-expanding valved stent for minimally invasive replacement of the mitral valve in animals. Methods: A newly designed nitinol stent was specially designed for this experimental acute study. It comprised of a left ventricular tubular stent with star shaped left atrial anchoring springs and carried a trileaflet bovine pericardial valve. A polytetrafluoroethylene membrane was sutured to envelop the atrial springs and the outside of the ventricular stent. The ventricular anchoring system was the same as in our previously reported results with a similar mitral valved stent. Seven pigs underwent minimally invasive off-pump mitral valved stent implantation. This was performed through a lower ministernotomy and a standard transapical approach under transoesophageal echocardiographic (TEE) guidance was used. Results: The valved stent is fully retrievable and precise deployment and accurate adjustment of its intra-annular position is achievable to eliminate paravalvular leakage. The deployment time ranged from 127 to 255 s and the blood loss from 70 to 220 cc. One animal died of intractable ventricular fibrillation. Mitral regurgitation in all surviving animals was minimal (trace in 5/6 and mild in 1/6 during echo examination; on the contrast ventriculogram no mitral insufficiency was observed except in one documented as mild paravalvular regurgitation). These animals remained haemodynamically stable (6/ 6) and without TEE or ventriculographic changes for 1 h. Conclusion: Implantation of a tricuspid bovine pericardial valved stent in the mitral position is feasible in pigs through a transcatheter approach. This was possible through a smaller delivery system than previously reported. Additional studies are required to demonstrate long-term feasibility, durability, and heart function. #

Research paper thumbnail of 408: Ventricular Assist Device Patients Managed Safely at Home 100 Miles or More from Implant Center

J Heart Lung Transplant, 2008

Purpose: Primary graft dysfunction (PGD) is a major obstacle limiting success of clinical lung tr... more Purpose: Primary graft dysfunction (PGD) is a major obstacle limiting success of clinical lung transplantation (LTX). PGD involves an influx of polymorphonuclear neutrophils to the graft with exacerbation of inflammation. Reparixin is a specific, non-competitive, allosteric, blocker of the two receptors (CXCR1 and 2) of CXCL8, a chemokine involved in leukocyte recruitment to the lung. This study evaluates safety and efficacy of Reparixin in clinical LTX. Methods and Materials: 223 patients were screened, 114 were randomized. Thirteen randomized patients were annulled; 7 because the LTX was canceled, 2 because the study drug was not delivered, and 4 for other reasons. Thus, 101 patients were entered. Primary endpoints evaluated were PaO2/FiO2 ratios immediately and 24 hours after LTX. Results: Of 101 patients entered, 46 received Reparixin and 55 received placebo. Groups were comparable in recipient age, gender, race, CMV status and lung allocation score. Donor age, gender and cause of death were equivalent in the groups. The primary efficacy endpoint (PaO2/FiO2 ratio) did not significantly differ between groups immediately or at 24 hours post-op. The values were (332Ϯ19) for the Reparixin group and (319Ϯ19) for the controls at time zero; and (305Ϯ24) for the Reparixin group and (290Ϯ20) for the controls at 24 hours. Adverse events did not differ between groups. All 46 Reparixin patients survived to month 1, while 3 patients in the placebo group failed to reach the 1 month endpoint. Two of these patients were re-transplanted and one died. Mortality in the first 12 months after transplant was 6/55 (11%) in the placebo group and 0/46 (0%) in the Reparixin group.(pϭ.03). Conclusions: In this study, treatment with Reparixin did not significantly impact PaO2/FiO2 ratios immediately or 24 hours after LTX. There were no apparent safety issues with the drug at the doses provided. The short and long term benefits in patient and graft survival are intriguing and merit additional study in this clinical setting.

Research paper thumbnail of Surgery Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Discrepancy Between Intraoperative Transesophageal Echocardiography and

Research paper thumbnail of Evaluation of the Appropriate Root Pressure for Maintaining Heartbeat during an Aortic Cross-clamp for Primary Repair of the Aortic Arch in Premature Infants with Associated Cardiac Anomalies

Acta Medica Okayama, Dec 1, 2010

We developed a new cardiopulmonary bypass (CPB) method to minimize myocardial damage during aorti... more We developed a new cardiopulmonary bypass (CPB) method to minimize myocardial damage during aortic arch reconstruction. In this method, coronary flow and heartbeat were stabilized by maintaining the aortic root pressure with an adjusted preload of the ventricle during aortic cross-clamping. This study was performed to determine the appropriate root pressure to maintain the heartbeat without causing deterioration of ventricular function. Study 1. Under partial CPB, the ascending aorta was cross-clamped in 6 pigs (group 1). Experimental data at various systolic aortic root pressures was analysed to determine the appropriate root pressure. Study 2. In group 2 (control, n＝6), the aorta was not clamped, while in group 3 (n＝6), the aorta was cross-clamped for 60 min and the systolic aortic root pressure was maintained at the pressure determined in study 1. Study 1. The diastolic coronary flow was stabilized at values comparable to that before initiation of CPB (6.6±1.4 ml/beat) when the systolic aortic root pressure was above 80 mmHg. Intracardiac pressure and the myocardial oxygen consumption (MvO2) seemed to be acceptable when the systolic aortic root pressure was below 100 mmHg. Therefore, 90 mmHg was selected for study 2. Study 2. Perioperative cardiac function did not differ between the groups. We concluded that 90 mmHg was the systolic aortic root pressure appropriate for this method.

Research paper thumbnail of Negative results - Thoracic general Unusual late presentation of asymptomatic diaphragmatic hernia following ventricular assist device explantation

The role of left ventricular assist device (LVAD ) in treatment options of congestive heart failu... more The role of left ventricular assist device (LVAD ) in treatment options of congestive heart failure is becoming more important and the widespread application is imminent. There are, however, some serious complications associated with LVAD, which make patient management more challenging. We report a rare surgical case of asymptomatic diaphragmatic hernia, which was diagnosed 8.5 years after heart transplantation and

Research paper thumbnail of To Explant or Not to Explant: An Invasive and Noninvasive Monitoring Protocol to Determine the Need of Continued Ventricular Assist Device Support

Congestive Heart Failure, Mar 1, 2009

Research paper thumbnail of Diagnosis-Based Differences in Response of Global Ventricular Performance to Modified Ultrafiltration in Children

Circ J, 2010

To determine diagnosis-based differences in the response of global ventricular performance to mod... more To determine diagnosis-based differences in the response of global ventricular performance to modified ultrafiltration (MUF) using transesophageal echocardiography during congenital heart surgery. The study included 38 children with atrial septal defect (n=10), ventricular septal defect (VSD) (n=8), tetralogy of Fallot (TOF) (n=9), or a single ventricle (n=11). Arteriovenous MUF was performed for 10-15 min after cardiopulmonary bypass (CPB). The myocardial performance index (MPI) of the systemic ventricles and the % change in MPI before and after MUF were assessed. Impairment of MPI was noted at termination of CPB compared with baseline values in the VSD and TOF groups (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). MUF resulted in an improvement in MPI in all groups (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). There was a weak correlation between aortic cross-clamping or CPB time, and the degree of improvement in MPI (r= 0.385, P=0.019; r= 0.348, P=0.037, respectively). MUF improved fractional shortening in all groups (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and reversed abnormal relaxation in the VSD and TOF groups. Modified ultrafiltration ameliorated MPI in all groups, indicating improved systemic ventricular function with MUF. The MPI recovery rate differed among the groups. MUF may be particularly useful for restoring the global ventricular performance of patients undergoing longer CPB and may have minimal advantages for simple open-heart surgery. (Circ J 2010; 74: 86 - 92).

Research paper thumbnail of 566: Improved Outcomes after Ventricular Assist Device Implantation in Patients Requiring Intra-Aortic Balloon Pump

J Heart Lung Transplant, 2010

Research paper thumbnail of Free radical scavenger MCI-186 ameliorates reperfusion injury in hearts harvested from non-heart-beating-donors

J Heart Lung Transplant, 2005

To project how use of NHBD hearts could increase heart donation, we retrospectively reviewed dono... more To project how use of NHBD hearts could increase heart donation, we retrospectively reviewed donor databases from Gift of Life Donor Program (GLDP), our local procurement organization, from 2001-2003. We screened the NHBD population using conservative donor criteria, assuming an acceptable hypoxic/ischemic time (time from withdrawal of care to cross clamp) of 30 min. Results: During the study period there were 894 HBDs, 334 heart transplants, and 119 NHBDs. During this time the number of HBDs increased by 5%, and the NHBD pool increased by 22%. NHBDs were similar to HBDs with respect to gender and ethnicity, but NHBDs were proportionately younger. Of 119 NHBDs, 55 did not meet the age criteria (Յ45 yrs), and 20 were eliminated for incomplete data. 20 NHBDs met all cardiac donor criteria. 82 NHBDs were cross-clamped within 30 min of care withdrawal. 14 of 20 NHBDs met cardiac donor criteria and had hypoxic/ischemic times Յ30 min. Pro rata estimation for the 20 NHBDs with incomplete data suggested 7 potential additional donors. Conclusion: The annual number of NHBDs increased while that of HBDs remained essentially fixed. NHBDs were demographically similar to HBDs in terms of gender and race but included a relatively greater proportion of younger individuals. If NHBD hearts identified by our criteria could have been transplanted, they would have provided GLDP with 14 to 21 additional hearts in a time interval in which 334 heart transplants were performed.

Research paper thumbnail of A novel approach to prevent post-operative ileus after continuous-flow left ventricular assist device implantation: A retrospective cohort study

International Journal of Surgery, 2015

Patients with postoperative ileus (POI), a common post-surgical event, experience intense discomf... more Patients with postoperative ileus (POI), a common post-surgical event, experience intense discomfort. Various treatments targeting prevention of POI have shown to have an unpredictable effect. We introduced a novel postoperative bowel management protocol in patients implanted with a continuous-flow left ventricular assist device (CF-LVAD). The effect of this protocol on POI was evaluated. Patients receiving an old bowel management protocol (OBMP; 01/2007-03/2009) were compared with those receiving a new bowel management protocol (NBMP; 04/2009-12/2013). The OBMP consisted of advancing the diet as tolerated, bisacodyl suppositories and enemas with the goal of a bowel movement (BM) every 3 days. The NBMP consisted of clear liquids until first BM is achieved, then full liquids until the second BM, then advancing to goal diet. Docusate is given on postoperative day (POD) 1 and bisacodyl PR on POD2 with enemas if ileus develops. Enemas are added POD3 if no BM has occurred. Polyethylene glycol is considered daily for patients prone to constipation. The goal is a BM every 2 days. Patients were made nil per os (NPO) with any signs of ileus. One hundred eighteen patients were implanted with CF-LVADs during the study period. The incidence of ileus significantly decreased from 19% in the OBMP group to 4% percent in the NBMP group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In-hospital mortality was not different between the two groups (6% vs. 2% p = 0.35). A novel postoperative bowel management protocol successfully decreased the incidence of POI following CF-LVAD implant surgery at our institution.

Research paper thumbnail of Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis

The Annals of Thoracic Surgery, 2015

We investigated the incidence and causes of unplanned hospital readmissions after continuous-flow... more We investigated the incidence and causes of unplanned hospital readmissions after continuous-flow (CF) left ventricular assist device (LVAD) implantation. We also analyzed the impact of unplanned readmissions on post-CF-LVAD survival and the costs associated with each cause of readmission. We retrospectively reviewed 126 patients who underwent implantation with a CF-LVAD from January 2007 to December 2013. The timing of readmissions, hospital length of stay, and total length of device support were evaluated. Patients were followed up while receiving support, until transplantation, or until death. Direct hospital costs associated with each readmission were analyzed. In all, 103 patients underwent implantation for bridge to transplantation and 19 patients for destination therapy; 68 patients were readmitted 156 times (2.2 times/patient) as of the end of follow-up. The median follow-up period was 11 months. While receiving device support, patients spent 93% of their time out of the hospital. The causes of readmission included gastrointestinal bleeding (19%), driveline infection (13%), and stroke (8%). The median time to first readmission was 35 days. Thirty (44%) patients were readmitted within 30 days after discharge. The median direct hospital cost of a single readmission was $7,546. Device malfunction and arrhythmias were the most costly causes of readmission. There was no significant difference in long-term survival between readmitted patients and those who were not readmitted. Gastrointestinal bleeding and CF-LVAD-related infections were the leading causes of readmission. Patients with a CF-LVAD spent 93% of their time out of hospital after implantation, and readmissions did not have a negative impact on long-term survival. New approaches to minimize these adverse events will continue to improve the efficacy and decrease the cost of CF-LVAD therapy.

Research paper thumbnail of Impact of age on outcomes following continuous-flow left ventricular assist device implantation

Interactive cardiovascular and thoracic surgery, Jan 13, 2015

The goal of our study was to analyse the impact of age on outcomes in patients who underwent cont... more The goal of our study was to analyse the impact of age on outcomes in patients who underwent continuous-flow left ventricular assist device (CF-LVAD) placement at our institution. One hundred and twenty-eight patients were implanted with a CF-LVAD between January 2008 and June 2014. Eighty-five patients were implanted with the device as a bridge to transplant (BTT); the remaining (n = 43) were on destination therapy (DT). Each group was divided into patients <65 years old and ≥65 years old at device implantation. Patients were followed up for at least 24 months or until transplant or death. Eighty-five patients (66%) received a CF-LVAD as BTT. Patients ≥65 years old (n = 8) had a lower preoperative cardiac index and prothrombin time-international normalized ratio (P = 0.009), and a longer stay in the intensive care unit (P = 0.008). Adverse events including infections, re-exploration for bleeding, ischaemic and haemorrhagic stroke, renal failure and right heart failure were compa...

Research paper thumbnail of Traumatic pericardial rupture without cardiac injury

General thoracic and cardiovascular surgery, 2008

Pericardial rupture is a rare injury following blunt chest trauma. It is frequently fatal because... more Pericardial rupture is a rare injury following blunt chest trauma. It is frequently fatal because of serious complications such as cardiac herniation and/or contusion. We report a case of traumatic pericardial rupture without cardiac injury, which was incidentally identified intraoperatively. A 63-year-old woman was transported to the hospital after sustaining blunt chest trauma from a motor vehicle accident. Radiographic workup demonstrated multiple fractures, pulmonary contusion, and hemopneumothorax. A chest tube was inserted, and persistent bleeding was observed. An exploratory thoracotomy was performed, and active pulmonary bleeding was controlled. Further exploration revealed major pericardial rupture without cardiac herniation or intrapericardial injury, which was repaired by a bovine pericardial patch. Her postoperative course was uneventful. It is usually difficult to make a diagnosis of pericardial rupture, and a misdiagnosis often leads to a fatal consequence. Therefore, ...