I.-hui Wu - Academia.edu (original) (raw)

Papers by I.-hui Wu

Research paper thumbnail of Robotic Transmitral Approach for Hypertrophic Cardiomyopathy With Systolic Anterior Motion

Circulation Journal, 2018

approach for some cardiac surgeons. The transapical approach is mainly used to excise hypertrophi... more approach for some cardiac surgeons. The transapical approach is mainly used to excise hypertrophied muscle in the apical and mid-ventricular regions. 10,11 In patients with a LVOT pressure gradient >50 mmHg plus SAM and severe mitral regurgitation (MR), our surgical aim is to first excise the hypertrophied septum in order to reduce the LVOT pressure gradient and then to resolve the SAM and eliminate MR. We describe a robotic TM (RTM) approach to resolving septal hypertrophy muscle and eliminating MR using 1 cardiac incision and we compared the results using this approach with those of the open TA approach.

Research paper thumbnail of Migration of a Temporary Epicardial Pacing Wire to the Main Pulmonary Artery Trunk During the Acute Phase After Cardiac Surgery

Journal of Surgery, 2018

A 60-year-old man was referred to the emergency room of our hospital with back pain. During exami... more A 60-year-old man was referred to the emergency room of our hospital with back pain. During examination, he suffered a cardiopulmonary arrest. Suspecting acute coronary artery syndrome, emergency coronary angiography was performed. During percutaneous coronary intervention to the proximal left circumflex artery, cardiac tamponade occurred, and the patient was transferred to the operating room for an emergency repair of a left ventricular rupture. Before closing his chest, a Temporary Epicardial Pacing Wire (TEPW) was placed on the right ventricle. This wire was cut flush with the skin surface on postoperative day 7. On POD 28, the patient experienced an inflammatory reaction, and on POD 30, computed tomography revealed that this TEPW had migrated into the pulmonary artery. Under fluoroscopic guidance, the wire was extracted from the right ventricle and pulmonary artery using a gooseneck snare. After extraction, the patient's recovery was uneventful.

Research paper thumbnail of Dimerized plasmin fragment D as a potential biomarker to predict successful catheter-directed thrombolysis therapy in acute deep vein thrombosis

Phlebology / Venous Forum of the Royal Society of Medicine, Jan 7, 2014

The value of dimerized plasmin fragment D in the clinical monitoring during the catheter-directed... more The value of dimerized plasmin fragment D in the clinical monitoring during the catheter-directed thrombolysis in patients with acute deep vein thrombosis is not known. Dimerized plasmin fragment D levels in 24 patients with acute deep vein thrombosis undergoing catheter-directed thrombolysis were prospectively evaluated. The plasma dimerized plasmin fragment D level was measured serially before and at every 12 h during catheter-directed thrombolysis for 24 h. Technical success was defined as restoration of patency and flow with less than 50% residual thrombus by surveillance rotational venography. Technical success was achieved in 79.2% (19 of 24) of the treated limbs after catheter-directed thrombolysis. In univariate analysis, there was significant elevation of the dimerized plasmin fragment D at 12th h after starting the catheter-directed thrombolysis (P < 0.05) in patients with less than 50% residual thrombus stenosis. The optimal cut-off value of dimerized plasmin fragment ...

Research paper thumbnail of The survival of heart transplant recipients using cyclosporine and everolimus is not inferior to that using cyclosporine and mycophenolate

Heart transplantation has become the best available therapy for patients with refractory end-stag... more Heart transplantation has become the best available therapy for patients with refractory end-stage heart failure. Cyclosporine (CsA) and mycophenolate mofetil (MMF) are the 2 FDA-approved drugs to prevent posttransplant acute rejection episodes. The purpose of this study was to evaluate the result of heart transplantation treated with CsA and everolimus (EVL), compared with that of patients treated with CsA and MMF. From 2000 to 2009 heart transplantation was performed in 239 patients among whom we enrolled 93 patients with a serum creatinine values&lt;or=2.8 mg/dL after informed written consents. The 2 arms were a CE group, who received EVL (n=46) CsA, and steroid (n=46), and a CM group who received MMF, CsA, and steroid (n=47). There was no operative mortality in either groups. The 1- and 5-year survivals of the CE group were 97.67+/-2.22% and 80.23+/-6.87%, versus the CM group, 97.72+/-2.17% and 79.38+/-7.62%, respectively. There was significant difference between the 2 groups. Survival after heart transplantation under EVL or MMF plus CsA and steroid was good. The survival of patients under the regimen of EVL, CsA and, steroid was not inferior to that of subjects prescribed MMF, CsA and steroid up to 5 years.

Research paper thumbnail of Robotic mitral valve repair in infective endocarditis

Backgroud: Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitr... more Backgroud: Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results. Patients: From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43. Results: The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or-stenosis rate was 100% at one-year follow. Conclusions: Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good.

Research paper thumbnail of One-stage hybrid repair to thoracoabdominal aortic aneurysm

Open repair of a thoracoabdominal aortic aneurysm (TAAA) is associated with high rates of morbidi... more Open repair of a thoracoabdominal aortic aneurysm (TAAA) is associated with high rates of morbidity and mortality. This study reviewed the midterm outcomes of hybrid TAAA repair in high-risk patients at our institution. The clinical data of patients undergoing 1-stage hybrid repair of a TAAA between June 2007 and June 2011 were retrospectively analyzed. This study represents our experience with 10 patients at a single center who underwent 1-stage visceral hybrid procedures for complex thoracoabdominal aortic pathologies. There were 9 men and 1 woman with a median age of 65.7 years. The average preoperative European System for Cardiac Operative Risk Evaluation II score was 34.1%. The technical success rate with completion was 100%. No procedure was abandoned because of any aortic event. The 30-day mortality rate in this study was 10%. Overall major perioperative complication rates were 20%. Major complications included renal impairment requiring permanent support in 1 patient (10%) and paraplegia in 1 patient (10%). At a median follow-up of 20.1 months (range, 0.3-39 months), the overall survival rate was 70%. The primary graft patency rate was 96.8% (32/33). Only 1 renal artery graft was occluded. The midterm results in selected high-risk patients with TAAA undergoing 1-stage hybrid repair were encouraging. When open repair is hazardous and branched stent grafting is not an option, hybrid repair is a viable treatment alternative. However, larger study cohorts and longer durations of follow-up are necessary to provide data on the durability of aortic stent grafts and visceral artery reconstruction.

Research paper thumbnail of Association of Lower Extremity Arterial Calcification with Amputation and Mortality in Patients with Symptomatic Peripheral Artery Disease

PLoS ONE, 2014

Objective: The clinical implication of the coronary artery calcium score (CS) is well demonstrate... more Objective: The clinical implication of the coronary artery calcium score (CS) is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. Methods and Results: Eighty-two patients with symptomatic peripheral artery disease (age 61.0612.4 years) were followed for 21611 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03). During the follow-up period (21611 months), 29 (35%) patients underwent amputation, and 24 (29%) patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88fold (95% confidence interval [CI] 1.18-12.72, p = 0.03) and a 5.16-fold (95% CI 1.13-21.61, p = 0.04) higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. Conclusion: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and allcause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

Research paper thumbnail of Selective medical treatment of infected aneurysms of the aorta in high risk patients

Journal of Vascular Surgery, 2009

Background: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resec... more Background: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. Methods: Retrospective chart review. Results: Between 1995 and 2007, 22 cases of infected aortic aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall aneurysm-related mortality rate was 36% in Salmonella infected patients and 82% in non-Salmonella infected patients. Conclusion: Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.

Research paper thumbnail of Incorporating a pediatric concept into tricuspid valve endocarditis: One and a half ventricle repair

The Journal of Thoracic and Cardiovascular Surgery, 2006

Research paper thumbnail of How to size the main aortic endograft in a chimney procedure

The Journal of Thoracic and Cardiovascular Surgery, 2014

Research paper thumbnail of Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation

Journal of the American College of Cardiology, 2003

We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) ... more We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) with extracorporeal membrane oxygenation (ECMO) and the predictive factors for hospital discharge and ECMO weaning. BACKGROUND Prolonged CPR carries considerable associated mortality and morbidity. As yet, ECMO for prolonged CPR has no definite results. Only small groups of patients and no detailed analysis have been reported. METHODS Candidates for ECMO resuscitation were patients in cardiac arrest receiving CPR Ͼ10 min without return of spontaneous circulation and no absolute contraindication. Venoarterial ECMO was set up during CPR. We reviewed the data of 57 prolonged CPR patients who received ECMO during CPR over a six-year period. RESULTS The mean duration of CPR was 47.6 Ϯ 13.4 min and that of ECMO was 96.1 Ϯ 87.9 h. The rate of weaning was 66.7%, and the survival rate was 31.6%. Multiple-organ failure was the major reason for mortality, despite successful weaning. Among survivors, long-term follow-up revealed 88.9% survival, and only 5.6% had a severe neurologic deficit. The results indicate that a shorter CPR duration, postcardiotomy arrest, myocardial indicators, a hepatic indicator, and lactic acid are significantly correlated with both weaning and survival, whereas late damage (level on the third or seventh day of reperfusion) rather than initial damage (level on the first day) was more predictive of the results. CONCLUSIONS Prolonged CPR rescue by ECMO provides an acceptable survival rate and outcome in survivors. Our results of the selected cases encourage further investigations of the wider application of ECMO in CPR.

Research paper thumbnail of Ventricular Septal Rupture Following an Acute Inferior Wall Myocardial Infarction Detected by Computed Tomography Imaging

Journal of Cardiac Surgery, 2013

Research paper thumbnail of Is Old Age a Contraindication for Surgical Treatment in Acute Aortic Dissection? A Demographic Study of National Database Registry in Taiwan

Journal of Cardiac Surgery, 2008

Background: Acute aortic dissection is usually presented as a surgical emergent condition with hi... more Background: Acute aortic dissection is usually presented as a surgical emergent condition with high mortality rate. Whether any patient of an advanced age suffering from acute aortic type A dissection or complicated type B dissection should be referred for surgery still deserves debating. Materials and Methods: A retrospective study including 5654 patients with acute aortic dissection was collected from the National Health Insurance Databases from 1996 to 2001. Age, initial treatment modality, and the late outcome were the main factors to be investigated. Patients are grouped into the young age group when ages are less or equal to 70 and the old age group when over 70. We further subdivided both groups into operative and nonoperative subgroups, respectively, depending on patients receiving surgical intervention for acute aortic dissection or not. The endpoint mortality was defined by the patient death either related to or unrelated to cardiac causes. Results: A total of 5654 cases are with the mean age of 65.6 ± 14.0 years. The percentage of patients receiving operation was inversely related to the patient's age significantly (p < 0.05). In the old age group, the operative subgroup had both significantly higher survival rate at sixyear follow-up than the nonoperative group for both patients on admission and 30-day survivors (43.4 ± 3.5% vs. 29.8 ± 2.3%, p < 0.05; 70.0 ± 4.5% vs. 36.0 ± 2.8%, p < 0.05). The annual attrition rates of mortality were significantly higher in the nonoperative subgroup for both patients on admission and 30day survivors (p < 0.05). Conclusion: The trend toward more conservative treatment in the elderly still occurs in our common practice even with improving surgical techniques. In our study, we suggest that pertinent surgical strategies for acute aortic dissection are necessary to improve the outcome in elderly patients.

Research paper thumbnail of Hybrid Repair of Simultaneous Multiple Mycotic Aortic Aneurysms

Journal of Cardiac Surgery, 2013

Simultaneous mycotic aortic aneurysms are a rare but life-threatening complication. We describe t... more Simultaneous mycotic aortic aneurysms are a rare but life-threatening complication. We describe the technique of one stage hybrid open debranching and endovascular repair using three thoracic stent-graft devices deployed to cover the whole aorta to exclude multiple mycotic aneurysms.

Research paper thumbnail of A Common Disease With an Unusual Complication of Acute Abdomen

Gastroenterology, 2012

Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day... more Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day duration of progressive and diffuse abdominal pain. The pain, seemingly unrelated to meals or postural change, began with intermittent cramps and progressed to a steady, constant ache. Physical examination revealed marked lower quadrant tenderness, diffuse peritoneal sign, and reduced bowel sounds. Deep tenderness at McBurney's point was not obvious. Laboratory investigation disclosed leukocytosis with a left shift, and the remaining tests were unremarkable. Contrast-enhanced computed tomography (CT) was performed (Figure A). What is your diagnosis and management? See the GASTROENTEROLOGY web site (www.gastrojournal .org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Research paper thumbnail of Simultaneous Endovascular Treatment of a Ureteroiliac Fistula and Common Iliac Artery Occlusion

EJVES Extra, 2008

We report an unusual case of simultaneous ureteroiliac fistula and common iliac artery occlusion,... more We report an unusual case of simultaneous ureteroiliac fistula and common iliac artery occlusion, managed with an endovascular approach. A 69-year-old woman with ureteral transition cell carcinoma, who had a double J tube insertion for her left hydroureter for years, developed sudden onset of massive hematuria. CT scan showed a left common iliac arteryureteric fistula and right common iliac artery occlusion. This was successfully treated with covered stents.

Research paper thumbnail of Pseudoaneurysm after sutureless repair of left ventricular free wall rupture: Sequential magnetic resonance imaging demonstration

Asian Journal of Surgery, 2015

Sutureless repair is an effective procedure for acute left ventricular free wall rupture; however... more Sutureless repair is an effective procedure for acute left ventricular free wall rupture; however, it may be complicated with a left ventricular pseudoaneurysm during the late postoperative period. We present a case of a large ventricular pseudoaneurysm that occurred after the sutureless repair of an inferior myocardial infarction with oozing left ventricular free wall rupture. The patient underwent aneurysmectomy successfully. Serial magnetic resonance imaging (MRI) indicated that the necrotic left ventricular wall, which was covered by Teflon felt, had ruptured and developed a pseudoaneurysm. Therefore, after simple gluing for a left ventricular free wall rupture, patients should undergo careful follow-up evaluation for potential pseudoaneurysm. Moreover, early detection by MRI and prompt surgical repair of the complication are important in patients with left ventricular free wall rupture.

Research paper thumbnail of Long-term Outcome of Endovascular Treatment for Mycotic Aortic Aneurysm

European Journal of Vascular and Endovascular Surgery, 2017

WHAT THIS PAPER ADDS Endovascular repair (EVAR) has been described a safe and viable alternative ... more WHAT THIS PAPER ADDS Endovascular repair (EVAR) has been described a safe and viable alternative for high risk patients presenting with mycotic aortic aneurysm (MAA). The present analysis of 40 consecutive cases not only demonstrates the feasibility of EVAR for MAA, but also shows a considerable proportion of persistent infection despite prolonged antibiotic treatment. Both positive blood cultures before and persistent infection after EVAR seemed closely associated with a poor prognosis as a result of fatal infectious complications when further surgical treatment was not performed. This suggests that infections should be treated with antibiotics as comprehensively as possible before endovascular repair. Objective/Background: Endovascular repair (EVAR) of mycotic aortic aneurysm (MAA) has become an alternative treatment for high risk patients. The aim of this study was to evaluate long-term survival and outcomes. Methods: Retrospective analysis of 40 consecutive patients with MAAs undergoing EVAR and subsequent intravenous antibiotic treatment between September 2009 and April 2015. Follow-up was truncated on 30 April 2015. Uni-and multivariate logistic regression were used to assess risk factors of adverse outcomes. Cumulative survival was calculated using the KaplaneMeier method. Results: Median age at repair was 73 years (range 48e88 years) and 31 (77%) were men. Eleven (27%) patients were infected with Salmonella, 12 (30%) with non-Salmonella species, and 17 (42%) had negative cultures. Anatomical locations included the aortic arch/thoracic area in 10 (25%), the paravisceral area in seven (17%), and the infrarenal area in 23 (57%). Ten (25%) patients presented with aneurysm rupture and underwent emergency repair. Median follow-up was 25 months (range 1e69 months). Cumulative 1 and 5 year survival rates were 71% and 53%, respectively. Persistent or recurrent infection occurred in 20% (n ¼ 8). Patients with persistent infection were treated with long-term medical therapy, but all died (75%; n ¼ 6) within 6 months of repair. No survival difference was found between patients with or without Salmonella infections. However, there was a trend toward better survival in culture negative patients. Conclusion: EVAR of MAA is an acceptable alternative treatment of MAA. However, persistent infection after endovascular treatment does occur and is often fatal without surgical treatment.

Research paper thumbnail of Endovascular Repair for Retrograde Type A Intramural Haematoma with Intimal Tear in the Descending Thoracic Aorta

European Journal of Vascular and Endovascular Surgery, 2020

WHAT THIS PAPER ADDS This is the first report with mid term follow up on endovascular thoracic ao... more WHAT THIS PAPER ADDS This is the first report with mid term follow up on endovascular thoracic aortic repair for patients with acute retrograde type A intramural haematoma with intimal tear in the descending thoracic aorta. It now includes 18 patients from four institutions and demonstrates that thoracic endovascular aneurysm repair is feasible and a promising alternative for the treatment of this complex type of pathology Objective: The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA Methods: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed. Results: The median age at repair was 58.1 years (range 38e86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 AE 3.6 and 45.7 AE 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7e78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage. Conclusion: In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up.

Research paper thumbnail of Comparisons of aortic remodelling and outcomes after endovascular repair of acute and chronic complicated Type B aortic dissections

Interactive cardiovascular and thoracic surgery, 2018

Patients with acute (ACTBAD) or chronic complicated Type B aortic dissection (CCTBAD) undergoing ... more Patients with acute (ACTBAD) or chronic complicated Type B aortic dissection (CCTBAD) undergoing thoracic endovascular aortic repair (TEVAR) remain at high risk for late aorta-related events. Few data exist on the comparison of aortic remodelling and outcomes after TEVAR between both groups. Forty-nine patients of TEVAR for CCTBAD (n = 26) and ACTBAD (n = 23) were retrospectively reviewed at our centre. The overall 30-day mortality was 4%. Cumulative freedom from all-cause mortality (ACTBAD: 77.6%, CCTBAD: 68.8%; P = 0.76), aneurysmal-related mortality (ACTBAD: 88.2%, CCTBAD: 95.0%; P = 0.63) and the 3-year reintervention rate (ACTBAD: 92.3%, CCTBAD: 95.6%; P = 0.94) were the same in both groups. Aortic remodelling was significant (P < 0.001) above the coeliac level after TEVAR. Thirty-five (75.5%) patients still experienced false lumen flow in the abdominal aorta below the coeliac artery (ACTBAD: 16, CCTBAD: 19, P = 0.10). No difference was found in aortic remodelling between th...

Research paper thumbnail of Robotic Transmitral Approach for Hypertrophic Cardiomyopathy With Systolic Anterior Motion

Circulation Journal, 2018

approach for some cardiac surgeons. The transapical approach is mainly used to excise hypertrophi... more approach for some cardiac surgeons. The transapical approach is mainly used to excise hypertrophied muscle in the apical and mid-ventricular regions. 10,11 In patients with a LVOT pressure gradient >50 mmHg plus SAM and severe mitral regurgitation (MR), our surgical aim is to first excise the hypertrophied septum in order to reduce the LVOT pressure gradient and then to resolve the SAM and eliminate MR. We describe a robotic TM (RTM) approach to resolving septal hypertrophy muscle and eliminating MR using 1 cardiac incision and we compared the results using this approach with those of the open TA approach.

Research paper thumbnail of Migration of a Temporary Epicardial Pacing Wire to the Main Pulmonary Artery Trunk During the Acute Phase After Cardiac Surgery

Journal of Surgery, 2018

A 60-year-old man was referred to the emergency room of our hospital with back pain. During exami... more A 60-year-old man was referred to the emergency room of our hospital with back pain. During examination, he suffered a cardiopulmonary arrest. Suspecting acute coronary artery syndrome, emergency coronary angiography was performed. During percutaneous coronary intervention to the proximal left circumflex artery, cardiac tamponade occurred, and the patient was transferred to the operating room for an emergency repair of a left ventricular rupture. Before closing his chest, a Temporary Epicardial Pacing Wire (TEPW) was placed on the right ventricle. This wire was cut flush with the skin surface on postoperative day 7. On POD 28, the patient experienced an inflammatory reaction, and on POD 30, computed tomography revealed that this TEPW had migrated into the pulmonary artery. Under fluoroscopic guidance, the wire was extracted from the right ventricle and pulmonary artery using a gooseneck snare. After extraction, the patient's recovery was uneventful.

Research paper thumbnail of Dimerized plasmin fragment D as a potential biomarker to predict successful catheter-directed thrombolysis therapy in acute deep vein thrombosis

Phlebology / Venous Forum of the Royal Society of Medicine, Jan 7, 2014

The value of dimerized plasmin fragment D in the clinical monitoring during the catheter-directed... more The value of dimerized plasmin fragment D in the clinical monitoring during the catheter-directed thrombolysis in patients with acute deep vein thrombosis is not known. Dimerized plasmin fragment D levels in 24 patients with acute deep vein thrombosis undergoing catheter-directed thrombolysis were prospectively evaluated. The plasma dimerized plasmin fragment D level was measured serially before and at every 12 h during catheter-directed thrombolysis for 24 h. Technical success was defined as restoration of patency and flow with less than 50% residual thrombus by surveillance rotational venography. Technical success was achieved in 79.2% (19 of 24) of the treated limbs after catheter-directed thrombolysis. In univariate analysis, there was significant elevation of the dimerized plasmin fragment D at 12th h after starting the catheter-directed thrombolysis (P < 0.05) in patients with less than 50% residual thrombus stenosis. The optimal cut-off value of dimerized plasmin fragment ...

Research paper thumbnail of The survival of heart transplant recipients using cyclosporine and everolimus is not inferior to that using cyclosporine and mycophenolate

Heart transplantation has become the best available therapy for patients with refractory end-stag... more Heart transplantation has become the best available therapy for patients with refractory end-stage heart failure. Cyclosporine (CsA) and mycophenolate mofetil (MMF) are the 2 FDA-approved drugs to prevent posttransplant acute rejection episodes. The purpose of this study was to evaluate the result of heart transplantation treated with CsA and everolimus (EVL), compared with that of patients treated with CsA and MMF. From 2000 to 2009 heart transplantation was performed in 239 patients among whom we enrolled 93 patients with a serum creatinine values&lt;or=2.8 mg/dL after informed written consents. The 2 arms were a CE group, who received EVL (n=46) CsA, and steroid (n=46), and a CM group who received MMF, CsA, and steroid (n=47). There was no operative mortality in either groups. The 1- and 5-year survivals of the CE group were 97.67+/-2.22% and 80.23+/-6.87%, versus the CM group, 97.72+/-2.17% and 79.38+/-7.62%, respectively. There was significant difference between the 2 groups. Survival after heart transplantation under EVL or MMF plus CsA and steroid was good. The survival of patients under the regimen of EVL, CsA and, steroid was not inferior to that of subjects prescribed MMF, CsA and steroid up to 5 years.

Research paper thumbnail of Robotic mitral valve repair in infective endocarditis

Backgroud: Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitr... more Backgroud: Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results. Patients: From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43. Results: The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or-stenosis rate was 100% at one-year follow. Conclusions: Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good.

Research paper thumbnail of One-stage hybrid repair to thoracoabdominal aortic aneurysm

Open repair of a thoracoabdominal aortic aneurysm (TAAA) is associated with high rates of morbidi... more Open repair of a thoracoabdominal aortic aneurysm (TAAA) is associated with high rates of morbidity and mortality. This study reviewed the midterm outcomes of hybrid TAAA repair in high-risk patients at our institution. The clinical data of patients undergoing 1-stage hybrid repair of a TAAA between June 2007 and June 2011 were retrospectively analyzed. This study represents our experience with 10 patients at a single center who underwent 1-stage visceral hybrid procedures for complex thoracoabdominal aortic pathologies. There were 9 men and 1 woman with a median age of 65.7 years. The average preoperative European System for Cardiac Operative Risk Evaluation II score was 34.1%. The technical success rate with completion was 100%. No procedure was abandoned because of any aortic event. The 30-day mortality rate in this study was 10%. Overall major perioperative complication rates were 20%. Major complications included renal impairment requiring permanent support in 1 patient (10%) and paraplegia in 1 patient (10%). At a median follow-up of 20.1 months (range, 0.3-39 months), the overall survival rate was 70%. The primary graft patency rate was 96.8% (32/33). Only 1 renal artery graft was occluded. The midterm results in selected high-risk patients with TAAA undergoing 1-stage hybrid repair were encouraging. When open repair is hazardous and branched stent grafting is not an option, hybrid repair is a viable treatment alternative. However, larger study cohorts and longer durations of follow-up are necessary to provide data on the durability of aortic stent grafts and visceral artery reconstruction.

Research paper thumbnail of Association of Lower Extremity Arterial Calcification with Amputation and Mortality in Patients with Symptomatic Peripheral Artery Disease

PLoS ONE, 2014

Objective: The clinical implication of the coronary artery calcium score (CS) is well demonstrate... more Objective: The clinical implication of the coronary artery calcium score (CS) is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. Methods and Results: Eighty-two patients with symptomatic peripheral artery disease (age 61.0612.4 years) were followed for 21611 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03). During the follow-up period (21611 months), 29 (35%) patients underwent amputation, and 24 (29%) patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88fold (95% confidence interval [CI] 1.18-12.72, p = 0.03) and a 5.16-fold (95% CI 1.13-21.61, p = 0.04) higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. Conclusion: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and allcause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

Research paper thumbnail of Selective medical treatment of infected aneurysms of the aorta in high risk patients

Journal of Vascular Surgery, 2009

Background: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resec... more Background: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. Methods: Retrospective chart review. Results: Between 1995 and 2007, 22 cases of infected aortic aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall aneurysm-related mortality rate was 36% in Salmonella infected patients and 82% in non-Salmonella infected patients. Conclusion: Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.

Research paper thumbnail of Incorporating a pediatric concept into tricuspid valve endocarditis: One and a half ventricle repair

The Journal of Thoracic and Cardiovascular Surgery, 2006

Research paper thumbnail of How to size the main aortic endograft in a chimney procedure

The Journal of Thoracic and Cardiovascular Surgery, 2014

Research paper thumbnail of Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation

Journal of the American College of Cardiology, 2003

We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) ... more We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) with extracorporeal membrane oxygenation (ECMO) and the predictive factors for hospital discharge and ECMO weaning. BACKGROUND Prolonged CPR carries considerable associated mortality and morbidity. As yet, ECMO for prolonged CPR has no definite results. Only small groups of patients and no detailed analysis have been reported. METHODS Candidates for ECMO resuscitation were patients in cardiac arrest receiving CPR Ͼ10 min without return of spontaneous circulation and no absolute contraindication. Venoarterial ECMO was set up during CPR. We reviewed the data of 57 prolonged CPR patients who received ECMO during CPR over a six-year period. RESULTS The mean duration of CPR was 47.6 Ϯ 13.4 min and that of ECMO was 96.1 Ϯ 87.9 h. The rate of weaning was 66.7%, and the survival rate was 31.6%. Multiple-organ failure was the major reason for mortality, despite successful weaning. Among survivors, long-term follow-up revealed 88.9% survival, and only 5.6% had a severe neurologic deficit. The results indicate that a shorter CPR duration, postcardiotomy arrest, myocardial indicators, a hepatic indicator, and lactic acid are significantly correlated with both weaning and survival, whereas late damage (level on the third or seventh day of reperfusion) rather than initial damage (level on the first day) was more predictive of the results. CONCLUSIONS Prolonged CPR rescue by ECMO provides an acceptable survival rate and outcome in survivors. Our results of the selected cases encourage further investigations of the wider application of ECMO in CPR.

Research paper thumbnail of Ventricular Septal Rupture Following an Acute Inferior Wall Myocardial Infarction Detected by Computed Tomography Imaging

Journal of Cardiac Surgery, 2013

Research paper thumbnail of Is Old Age a Contraindication for Surgical Treatment in Acute Aortic Dissection? A Demographic Study of National Database Registry in Taiwan

Journal of Cardiac Surgery, 2008

Background: Acute aortic dissection is usually presented as a surgical emergent condition with hi... more Background: Acute aortic dissection is usually presented as a surgical emergent condition with high mortality rate. Whether any patient of an advanced age suffering from acute aortic type A dissection or complicated type B dissection should be referred for surgery still deserves debating. Materials and Methods: A retrospective study including 5654 patients with acute aortic dissection was collected from the National Health Insurance Databases from 1996 to 2001. Age, initial treatment modality, and the late outcome were the main factors to be investigated. Patients are grouped into the young age group when ages are less or equal to 70 and the old age group when over 70. We further subdivided both groups into operative and nonoperative subgroups, respectively, depending on patients receiving surgical intervention for acute aortic dissection or not. The endpoint mortality was defined by the patient death either related to or unrelated to cardiac causes. Results: A total of 5654 cases are with the mean age of 65.6 ± 14.0 years. The percentage of patients receiving operation was inversely related to the patient's age significantly (p < 0.05). In the old age group, the operative subgroup had both significantly higher survival rate at sixyear follow-up than the nonoperative group for both patients on admission and 30-day survivors (43.4 ± 3.5% vs. 29.8 ± 2.3%, p < 0.05; 70.0 ± 4.5% vs. 36.0 ± 2.8%, p < 0.05). The annual attrition rates of mortality were significantly higher in the nonoperative subgroup for both patients on admission and 30day survivors (p < 0.05). Conclusion: The trend toward more conservative treatment in the elderly still occurs in our common practice even with improving surgical techniques. In our study, we suggest that pertinent surgical strategies for acute aortic dissection are necessary to improve the outcome in elderly patients.

Research paper thumbnail of Hybrid Repair of Simultaneous Multiple Mycotic Aortic Aneurysms

Journal of Cardiac Surgery, 2013

Simultaneous mycotic aortic aneurysms are a rare but life-threatening complication. We describe t... more Simultaneous mycotic aortic aneurysms are a rare but life-threatening complication. We describe the technique of one stage hybrid open debranching and endovascular repair using three thoracic stent-graft devices deployed to cover the whole aorta to exclude multiple mycotic aneurysms.

Research paper thumbnail of A Common Disease With an Unusual Complication of Acute Abdomen

Gastroenterology, 2012

Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day... more Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day duration of progressive and diffuse abdominal pain. The pain, seemingly unrelated to meals or postural change, began with intermittent cramps and progressed to a steady, constant ache. Physical examination revealed marked lower quadrant tenderness, diffuse peritoneal sign, and reduced bowel sounds. Deep tenderness at McBurney's point was not obvious. Laboratory investigation disclosed leukocytosis with a left shift, and the remaining tests were unremarkable. Contrast-enhanced computed tomography (CT) was performed (Figure A). What is your diagnosis and management? See the GASTROENTEROLOGY web site (www.gastrojournal .org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Research paper thumbnail of Simultaneous Endovascular Treatment of a Ureteroiliac Fistula and Common Iliac Artery Occlusion

EJVES Extra, 2008

We report an unusual case of simultaneous ureteroiliac fistula and common iliac artery occlusion,... more We report an unusual case of simultaneous ureteroiliac fistula and common iliac artery occlusion, managed with an endovascular approach. A 69-year-old woman with ureteral transition cell carcinoma, who had a double J tube insertion for her left hydroureter for years, developed sudden onset of massive hematuria. CT scan showed a left common iliac arteryureteric fistula and right common iliac artery occlusion. This was successfully treated with covered stents.

Research paper thumbnail of Pseudoaneurysm after sutureless repair of left ventricular free wall rupture: Sequential magnetic resonance imaging demonstration

Asian Journal of Surgery, 2015

Sutureless repair is an effective procedure for acute left ventricular free wall rupture; however... more Sutureless repair is an effective procedure for acute left ventricular free wall rupture; however, it may be complicated with a left ventricular pseudoaneurysm during the late postoperative period. We present a case of a large ventricular pseudoaneurysm that occurred after the sutureless repair of an inferior myocardial infarction with oozing left ventricular free wall rupture. The patient underwent aneurysmectomy successfully. Serial magnetic resonance imaging (MRI) indicated that the necrotic left ventricular wall, which was covered by Teflon felt, had ruptured and developed a pseudoaneurysm. Therefore, after simple gluing for a left ventricular free wall rupture, patients should undergo careful follow-up evaluation for potential pseudoaneurysm. Moreover, early detection by MRI and prompt surgical repair of the complication are important in patients with left ventricular free wall rupture.

Research paper thumbnail of Long-term Outcome of Endovascular Treatment for Mycotic Aortic Aneurysm

European Journal of Vascular and Endovascular Surgery, 2017

WHAT THIS PAPER ADDS Endovascular repair (EVAR) has been described a safe and viable alternative ... more WHAT THIS PAPER ADDS Endovascular repair (EVAR) has been described a safe and viable alternative for high risk patients presenting with mycotic aortic aneurysm (MAA). The present analysis of 40 consecutive cases not only demonstrates the feasibility of EVAR for MAA, but also shows a considerable proportion of persistent infection despite prolonged antibiotic treatment. Both positive blood cultures before and persistent infection after EVAR seemed closely associated with a poor prognosis as a result of fatal infectious complications when further surgical treatment was not performed. This suggests that infections should be treated with antibiotics as comprehensively as possible before endovascular repair. Objective/Background: Endovascular repair (EVAR) of mycotic aortic aneurysm (MAA) has become an alternative treatment for high risk patients. The aim of this study was to evaluate long-term survival and outcomes. Methods: Retrospective analysis of 40 consecutive patients with MAAs undergoing EVAR and subsequent intravenous antibiotic treatment between September 2009 and April 2015. Follow-up was truncated on 30 April 2015. Uni-and multivariate logistic regression were used to assess risk factors of adverse outcomes. Cumulative survival was calculated using the KaplaneMeier method. Results: Median age at repair was 73 years (range 48e88 years) and 31 (77%) were men. Eleven (27%) patients were infected with Salmonella, 12 (30%) with non-Salmonella species, and 17 (42%) had negative cultures. Anatomical locations included the aortic arch/thoracic area in 10 (25%), the paravisceral area in seven (17%), and the infrarenal area in 23 (57%). Ten (25%) patients presented with aneurysm rupture and underwent emergency repair. Median follow-up was 25 months (range 1e69 months). Cumulative 1 and 5 year survival rates were 71% and 53%, respectively. Persistent or recurrent infection occurred in 20% (n ¼ 8). Patients with persistent infection were treated with long-term medical therapy, but all died (75%; n ¼ 6) within 6 months of repair. No survival difference was found between patients with or without Salmonella infections. However, there was a trend toward better survival in culture negative patients. Conclusion: EVAR of MAA is an acceptable alternative treatment of MAA. However, persistent infection after endovascular treatment does occur and is often fatal without surgical treatment.

Research paper thumbnail of Endovascular Repair for Retrograde Type A Intramural Haematoma with Intimal Tear in the Descending Thoracic Aorta

European Journal of Vascular and Endovascular Surgery, 2020

WHAT THIS PAPER ADDS This is the first report with mid term follow up on endovascular thoracic ao... more WHAT THIS PAPER ADDS This is the first report with mid term follow up on endovascular thoracic aortic repair for patients with acute retrograde type A intramural haematoma with intimal tear in the descending thoracic aorta. It now includes 18 patients from four institutions and demonstrates that thoracic endovascular aneurysm repair is feasible and a promising alternative for the treatment of this complex type of pathology Objective: The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA Methods: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed. Results: The median age at repair was 58.1 years (range 38e86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 AE 3.6 and 45.7 AE 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7e78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage. Conclusion: In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up.

Research paper thumbnail of Comparisons of aortic remodelling and outcomes after endovascular repair of acute and chronic complicated Type B aortic dissections

Interactive cardiovascular and thoracic surgery, 2018

Patients with acute (ACTBAD) or chronic complicated Type B aortic dissection (CCTBAD) undergoing ... more Patients with acute (ACTBAD) or chronic complicated Type B aortic dissection (CCTBAD) undergoing thoracic endovascular aortic repair (TEVAR) remain at high risk for late aorta-related events. Few data exist on the comparison of aortic remodelling and outcomes after TEVAR between both groups. Forty-nine patients of TEVAR for CCTBAD (n = 26) and ACTBAD (n = 23) were retrospectively reviewed at our centre. The overall 30-day mortality was 4%. Cumulative freedom from all-cause mortality (ACTBAD: 77.6%, CCTBAD: 68.8%; P = 0.76), aneurysmal-related mortality (ACTBAD: 88.2%, CCTBAD: 95.0%; P = 0.63) and the 3-year reintervention rate (ACTBAD: 92.3%, CCTBAD: 95.6%; P = 0.94) were the same in both groups. Aortic remodelling was significant (P < 0.001) above the coeliac level after TEVAR. Thirty-five (75.5%) patients still experienced false lumen flow in the abdominal aorta below the coeliac artery (ACTBAD: 16, CCTBAD: 19, P = 0.10). No difference was found in aortic remodelling between th...